Beatriz Korc-Grodzicki1, Robert J Downey2, Armin Shahrokni2, T Peter Kingham2, Snehal G Patel2, Riccardo A Audisio2. 1. Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom. korcgrob@mskcc.org. 2. Beatriz Korc-Grodzicki, Robert J. Downey, Armin Shahrokni, T. Peter Kingham, and Snehal G. Patel, Memorial Sloan-Kettering Cancer Center, New York, NY; Riccardo A. Audisio, St Helens Teaching Hospital, University of Liverpool, St Helens, United Kingdom.
Abstract
PURPOSE: The aging of the population is a real concern for surgical oncologists, who are increasingly being asked to treat patients who would not have been considered for surgery in the past. In many cases, decisions are made with relatively little evidence, most of which was derived from trials in which older age was a limiting factor for recruitment. METHODS: This review focuses on risk assessment and perioperative management. It describes the relationship between age and outcomes for colon, lung, hepatobiliary, and head and neck cancer, which are predominantly diseases of the elderly and are a major cause of morbidity and mortality. RESULTS: Effective surgery requires safe performance as well as reasonable postoperative life expectancy and maintenance of quality of life. Treatment decisions for potentially vulnerable elderly patients should take into account data obtained from the evaluation of geriatric syndromes, such as frailty, functional and cognitive limitations, malnutrition, comorbidities, and polypharmacy, as well as social support. Postoperative care should include prevention and treatment of complications seen more frequently in the elderly, including postoperative delirium, functional decline, and the need for institutionalization. CONCLUSION: Surgery remains the best modality for treatment of solid tumors, and chronologic age alone should not be a determinant for treatment decisions. With adequate perioperative risk stratification, functional assessment, and oncologic prognostication, elderly patients with cancer can do as well in terms of morbidity and mortality as their younger counterparts. If surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.
PURPOSE: The aging of the population is a real concern for surgical oncologists, who are increasingly being asked to treat patients who would not have been considered for surgery in the past. In many cases, decisions are made with relatively little evidence, most of which was derived from trials in which older age was a limiting factor for recruitment. METHODS: This review focuses on risk assessment and perioperative management. It describes the relationship between age and outcomes for colon, lung, hepatobiliary, and head and neck cancer, which are predominantly diseases of the elderly and are a major cause of morbidity and mortality. RESULTS: Effective surgery requires safe performance as well as reasonable postoperative life expectancy and maintenance of quality of life. Treatment decisions for potentially vulnerable elderly patients should take into account data obtained from the evaluation of geriatric syndromes, such as frailty, functional and cognitive limitations, malnutrition, comorbidities, and polypharmacy, as well as social support. Postoperative care should include prevention and treatment of complications seen more frequently in the elderly, including postoperative delirium, functional decline, and the need for institutionalization. CONCLUSION: Surgery remains the best modality for treatment of solid tumors, and chronologic age alone should not be a determinant for treatment decisions. With adequate perioperative risk stratification, functional assessment, and oncologic prognostication, elderly patients with cancer can do as well in terms of morbidity and mortality as their younger counterparts. If surgery is determined to be the appropriate treatment modality, patients should not be denied this option because of their age.
Authors: Richard Baird; Ian Banks; David Cameron; John Chester; Helena Earl; Mark Flannagan; Adam Januszewski; Richard Kennedy; Sarah Payne; Emlyn Samuel; Hannah Taylor; Roshan Agarwal; Samreen Ahmed; Caroline Archer; Ruth Board; Judith Carser; Ellen Copson; David Cunningham; Rob Coleman; Adam Dangoor; Graham Dark; Diana Eccles; Chris Gallagher; Adam Glaser; Richard Griffiths; Geoff Hall; Marcia Hall; Danielle Harari; Michael Hawkins; Mark Hill; Peter Johnson; Alison Jones; Tania Kalsi; Eleni Karapanagiotou; Zoe Kemp; Janine Mansi; Ernie Marshall; Alex Mitchell; Maung Moe; Caroline Michie; Richard Neal; Tom Newsom-Davis; Alison Norton; Richard Osborne; Gargi Patel; John Radford; Alistair Ring; Emily Shaw; Rod Skinner; Dan Stark; Sam Turnbull; Galina Velikova; Jeff White; Alison Young; Johnathan Joffe; Peter Selby Journal: Ecancermedicalscience Date: 2016-01-05
Authors: Neda Amini; Gaya Spolverato; Rohan Gupta; Georgios A Margonis; Yuhree Kim; Doris Wagner; Neda Rezaee; Matthew J Weiss; Christopher L Wolfgang; Martin M Makary; Ihab R Kamel; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2015-04-30 Impact factor: 3.452