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Review
. 2017 Mar;22(3):335-342.
doi: 10.1634/theoncologist.2016-0276. Epub 2017 Feb 20.

Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions

María Vallet-Regí  1   2 , Miguel Manzano  3   2 , Leocadio Rodriguez-Mañas  4   5 , Marta Checa López  6 , Matti Aapro  7 , Lodovico Balducci  8
Affiliations
Review

Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions

María Vallet-Regí et al. Oncologist. 2017 Mar.

Abstract

The management of cancer in older aged people is becoming a common problem due to the aging of the population. There are many variables determining the complex situation that are interconnected. Some of them can be assessed, such as risk of mortality and risk of treatment complications, but many others are still unknown, such as the course of disease, the host-related factors that influence cancer aggressiveness, and the phenotype heralding risk of permanent treatment-related damage.This article presents a dynamic and personalized approach to older people with cancer based on our experience on aging, cancer, and their biological interactions. Also, novel treatments and management approaches to older individuals, based on their functional age and their social and emotional needs, are thoughtfully explored here. The Oncologist 2017;22:335-342 IMPLICATIONS FOR PRACTICE: The goal of this article is to suggest a practical approach to complexity, a clinical situation becoming increasingly common with the aging of the population. Beginning with the analysis of two clinical cases, the authors offer an algorithm for approaching cancer in the older person that involves the assessment of life expectancy without cancer, the risk that cancer might compromise a patient's survival, function, or quality of life, and the potential benefits and risks of the treatments based on a clinical evaluation. The authors then review possible laboratory assessment of functional age and the importance of rapid-learning databases in the study of cancer and age.

Keywords: Aging and Cancer; Complexity of Cancer in the Elderly; Geriatric Oncology; Personalized Treatment.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
A simple model to decide which treatment to offer to older cancer patients. Risk or mortality without cancer is established calculated with the e‐prognosis instrument [14]; risk of chemotherapy‐related toxicity is calculated with the Chemotherapy Risk Assessment Scale for High‐Age Patients (CRASH) [21] or the Classification and Regression Tree (CART) [22] instruments; and risk of surgical complication is calculated with the Preoperative Assessment in elderly Cancer Patients (PACE) [29] instrument. No instruments are available yet to estimate the risk of radiation therapy, combined chemoradiation, or targeted and biological therapy. All instruments may be fine‐tuned when integrated with biological markers of aging and with the new definition of frailty.
Figure 2.
Figure 2.
Treatment of case 2, based on the Figure 1 model.
None
See this image and copyright information in PMC

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