Special needs of elderly cancer patients must be more taken into account in clinical decision making  

Around 70 percent of elderly people who are battling cancer often suffer age-related health issues that can affect the outcome of their cancer treatment. The Quick G8 questionnaire proves valuable in geriatric assessment of elderly Belgian cancer patients.

This is the outcome of a recent study that was published in Annals of Oncology, conducted by the Catholic University of Leuven in 22 Belgian hospitals.¹ Research leader Professor Hans Wildiers, president of the International Society of Geriatric Oncology (SIG), notes that 45 percent of all cancer patients is over 70 years old.

Upon their first visit to an oncologist, patients were asked to fill in a quick G8 questionnaire that enables a quick assessment of the general health situation of a patient. Earlier research had shown that the answers in the G8 survey already gave a strong indication towards the outcome, regardless of the type of cancer.² In around 70 percent of cases, the G8 surveys showed a risk of frailty and other age-related problems. Geriatric evaluation is also useful in selecting the right therapy for each elderly cancer patient. Professor Wildiers’ study shows that the results of these geriatric evaluations however don’t seem to play a large part in determining treatment for elderly cancer patients. 8,500 cancer patients over 70 were monitored in 22 academic and non-academic hospitals in Belgium, at the moment of deciding on what treatment would suit them best. In most cases, this involved operations, radiation and chemotherapy. The quick G8-survey suggested that for 70 percent of the patients, a more detailed geriatric evaluation was indicated. And of all the patients that underwent this much more extensive survey, it was found out that 8 in 10 needed dietary support, psychological support, physiotherapy or special attention for memory or balance issues. It turned out that this extra help was often partially or fully absent.

Wildiers: ‘Oncologists are all specialists in their own field, but they should also be aware of the general condition of elderly patients. We are pleased that the G8-quickscan now is commonly used by oncology caregivers in Belgium, but we need to realize that merely identifying certain problems in elderly patients is not enough. We need to act on these findings. If a patient is severely undernourished, it is pointless to start chemotherapy until that problem is addressed. And a patient who suffers from memory problems will have difficulty remembering to take his or her medication in time. Patients who are prone to falling, and subsequently run a large risk of bone fractures, are perhaps also not necessarily better off with a demanding anticancer treatment.’

By combining targeted therapy with a milder type of chemotherapy, we were able to achieve good results with little or no impact on the quality of life of women over 70 with an aggressive type of metastatic breast cancer³

Currently, Professor Wildiers and his team are focusing on studies about alternative treatment regimens for elderly cancer patients. Recently, the team published findings in The Lancet Oncology that show that women over 70 with an aggressive type of metastatic breast cancer can be treated effectively with a combination of mild chemotherapy and targeted therapy.³ Wildiers: ‘By combining targeted therapy with a milder type of chemotherapy, we were able to achieve good results with little or no impact on quality of life.’

Literature
1. Kenis C, Decoster L, Flamaing J. et al. Adherence to geriatric assessment-based recommendations in older patients with cancer: A multicenter prospective cohort study in Belgium. Ann Oncol. 2018 Sep 1;29(9):1987-1994. doi: 10.1093/annonc/mdy210.
2. Martinez-Tapia C, Canoui-Poitrine F, Bastuji-Garin S, et al. Optimizing the G8 Screening Tool for Older Patients With Cancer: Diagnostic Performance and Validation of a Six-Item Version. Oncologist;2016 Feb;21(2):188–195.
3. Wildiers H, Tryfonidis K, Dal Lago L, et al. Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer (EORTC 75111-10114): an open-label, randomised, phase 2 trial from the Elderly Task Force/Breast Cancer Group. Lancet Oncol. 2018 Mar;19(3):323-336. doi: 10.1016/S1470-2045(18)30083-
4. Epub 2018 Feb