J. Tournoy MD, PhD

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)

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