C. Kenis RN, PhD

Long-term outcomes in older patients with cancer and the association with geriatric screening and assessment results

SUMMARY

Oncology care is tumour-centric by tradition, but especially in older patients, a more holistic approach is needed that takes into account each aspect of the patient’s health status and not just the tumour. Identifying areas of vulnerability with geriatric screening (GS) and/or geriatric assessment (GA) is crucial in providing patient-oriented and multidisciplinary care that is tailored to the patient’s general health status. The results of GS/GA allow the treating physician to apply clinical judgment based on an estimate of biological age to optimise cancer treatment decisions. The use of GS/GA is, however, not yet widespread in Belgian oncology practice so further evidence on what GS/GA results can contribute, particularly regarding long-term outcomes, was needed to further stimulate the systematic implementation. This study specifically aimed to explore the association between the GS (with Geriatric 8 or G8) / GA and long-term outcomes using linked clinical and population-based data from a cohort of older patients with cancer. It was demonstrated that older patients with an abnormal G8 score at cancer diagnosis had a significantly lower 10-year overall survival compared to patients with a normal G8 score. Furthermore, patients with an abnormal baseline G8 score displayed higher healthcare utilisation across primary care, hospital care, and residential care in the three years after cancer diagnosis. In deceased patients with an abnormal baseline G8 score, functional and cognitive impairment identified with GA at cancer diagnosis was associated with less specialised palliative care use in the last three months of life.

(BELG J MED ONCOL 2024;18(4):160–3)

SIOG 2023: Highlights from the International Society of Geriatric Oncology annual conference

SUMMARY

The annual meeting of the International Society of Geriatric Oncology (SIOG) unites each year different health care workers involved in the treatment of older patients with cancer with the goal of improving personalised care. This year, recent advances in the field of geriatric oncology were discussed, including randomised controlled trials and ASCO guidelines for the implementation of comprehensive geriatric assessment.

(Belg J Med Oncol 2024;18(2):68–70)

The value of population-based databases to evaluate long-term patient outcomes: A multicentric research project in older patients with cancer

SUMMARY

The use of population-based data is a relatively accessible and cost-effective approach to study long-term outcomes in oncology. Also in older patients with cancer, longer-term outcome studies are limited and population-based data could help address this gap. Under the lead of UZ Leuven and the Belgian Cancer Registry (BCR), a national study was initiated to explore the association between the general health status of older patients with cancer as assessed by geriatric screening and assessment, and long-term outcomes as captured by population-based data. To this extent, data previously gathered within the context of a multicentre clinical study will be linked with three population-based databases: cancer registration data from BCR, healthcare reimbursement data from InterMutualistic Agency and hospital discharge data from Technical Cell. The major advantage of these population-based data is their longitudinal nature, which allows to follow a (sub)population across several years. The downside is their lack of clinical information. One way to partially overcome this limitation is to supplement population-based data with primary study data to investigate more clinically relevant outcomes. Although often scientifically interesting and appealing, coupling with population-based data demands intensive administrative efforts including an authorisation demand at the Information Security Committee. During the whole process, special attention should be given to privacyrelated aspects of the use and linkage of these data to ensure confidentiality.

BELG J MED ONCOL 2021;15(7):362-6)

Geriatric syndromes in oncology: what does the oncologist need to know?

SUMMARY

A ‘Geriatric Syndrome’ is characterised by its multifactorial origin. A combination of impairments leads to one specific condition that is typical for frail older patients. The rising incidence of cancer among older adults makes it interesting for the oncologist to understand common geriatric syndromes. The following geriatric syndromes are presented in this article:

Delirium: In patients with cancer, the prevalence of delirium is high. In end-stage malignant disease a prevalence near 90% has been reported. The pathophysiology is characterised by an equilibrium between predisposing and precipitating factors. The more predisposing factors, the less precipitating factors are required to develop delirium, and vice versa. Delirium is often underdiagnosed, although it leads to increased morbidity and mortality. Screening tools, such as the Confusion Assessment Method or the 4 ’A’s Test, could help the oncologist to discover delirium. Prevention and non-pharmacological therapy are the cornerstone of the approach. Pharmacological therapy is only appropriate when non-pharmacological therapy is not successful or if delirium could harm the patient.

Cognitive decline: In Belgium, the prevalence of dementia is estimated at 7.4% in adults aged 65 and over. Apart from dementia, cognitive decline in oncologic patients could also be provoked by cancer or its treatment. Cognitive decline is prognostic for overall survival in older patients with cancer. The Mini-Cog is an easy screening tool for cognitive decline, but more extensive testing, e.g. by means of a Mini Mental State Examination, can also be applied. Referral to a memory clinic should be considered, taking into account oncological diagnosis and prognosis.

Urinary incontinence: About 15 to 35% of patients older than 60 years have urinary incontinence. Urinary incontinence is associated with falls and fractures, pressure ulcers, and urinary infection. It has an emotional impact, affects quality of life and is associated with higher depression rates. In predisposed patients, precipitating factors could trigger incontinence. Prevention is of high importance and is primarily aimed at treating the precipitating factors. Pharmacological treatment blocking muscarinic receptors is associated with important side effects.

Functional decline: One third of patients receiving chemotherapy suffer from functional decline. Functional decline is prognostic for overall survival. Baseline functional assessment before initiation of treatment is important. The oncologist has to define predisposing and precipitating factors and to estimate the risk of functional decline. A multidisciplinary approach with physiotherapists, occupational therapists, nurses and social workers is warranted to achieve optimal rehabilitation.

Falls: Thirty percent of patients older than 65 years have fall incidents. Ten percent of falls lead to residual injuries. Cancer and its treatment increase the risk of falling. Bone metastases or cancer therapy can lead to more severe injuries. Falls are often preventable. Therefore, risk stratification and formulation of a multifactorial fall prevention plan by a multidisciplinary team is warranted.

(BELG J MED ONCOL 2021;15(6):270-7)

Geriatric oncology: targeting older patients with cancer

SUMMARY

As the cancer population ages, treatment decisions in the older patients should not only be guided by the tumour characteristics but also by patient characteristics. The performance of a comprehensive geriatric assessment as well as a health related quality of life evaluation are important in order to deliver the optimal personalised care in older patients with cancer. The current PhD thesis focused on the use of screening tools, geriatric assessment and interventions as well as on health-related quality of life in older patients with cancer.

(BELG J MED ONCOL 2020;14(3):106–8)

Geriatric oncology: Integrative Oncology – Leaving no one behind

SUMMARY

The 2019 annual conference of the International Society of Geriatric Oncology took place in Geneva, Switzerland from November 14–16^th. This year, the International Society of Geriatric Oncology and the International Federation on Ageing also jointly hosted a meeting at the United Nations on the development and preparation of health care professionals for the ageing population with cancer.

(BELG J MED ONCOL 2020;14(3):114–5)

Geriatric oncology: becoming mainstream cancer care

SUMMARY

The 2018 annual conference of the International Society of Geriatric Oncology took place in Amsterdam, the Netherlands from November 16–18th. More than 500 delegates from 41 countries with a special interest in the care for older patients with cancer attended this conference. The meeting provided an overview of current advances in geriatric oncology.

(BELG J MED ONCOL 2019;13(2):60–62)