Management of elderly and frail elderly cancer patients: the importance of comprehensive geriatrics assessment and the need for guidelines.

OBJECTIVES: Management of elderly and frail patients with cancer is complex and requires a multidisciplinary approach. This article reviews and discusses the current literature that evaluates the relevance of comprehensive geriatrics assessment (CGA) and other evaluation tools in the detection of this vulnerable patient population.
METHODS: A literature search of articles in English, Spanish and Portuguese was conducted in PubMed through September 2011.
RESULTS: There is lack of detailed information concerning the efficacy, tolerability and toxicity of cancer therapies in senior adults, although the literature indicates that there is a trend toward including elderly patients and their outcome. Recent guidelines advocate a careful patient selection through a CGA. For vulnerable (pre-frail) and frail elderly cancer patients, there is no consensus in relation to selection and type of treatments. CGA has been advocated as the gold standard for evaluation of elderly patients, but thorough evaluation of vulnerable and frail patients has not been undertaken. A tool to evaluate vulnerable elderly patients to predict treatment outcomes is also needed. DISCUSSION: The adoption of the CGA in oncology practice has been slow because of the difficulties with practicality and objectivity. A shorter reliable tool for rapid and complete assessment is needed. Inclusion of frail elderly patients in treatment trials is recommended. New treatment approaches for frail elderly cancer patients need to be further investigated. Some studies that used serum markers of frailty found that even in the absence of clinical signs, some elderly patients might be already vulnerable. A potential cancer frailty index also needs further investigation.