What Is Geriatric Oncology?
Geriatric oncology deals with old-age individuals who suffer from cancers. It is a multidimensional approach that emphasizes providing treatment for the disease along with the treatment modalities that have the least effect on the mental capacity of the patient and the overall life of the patient. Old age is most vulnerable to stress, and the diagnosis of any kind of cancer lands the patient into depression. While the patient is supposedly meant to cherish the final stage of life, the grief of diagnosis and treatment modalities affects the quality of life. Hence, it becomes mandatory to balance the treatment efficacy and quality of life. Geriatric oncology deals with patients who are 65 and above.
What Is Geriatic Assessment, and How Does It Help in Patients of Geriatic Oncology?
Geriatric assessment or comprehensive geriatric assessment is a multi-dimensional treatment plan for the geriatric patient to maintain a balance between treatment efficacy and quality of life. Aging is a complex phenomenon. As one approaches old age, there is a change in gait, memory, and cognition. Treating an old individual poses more challenges than treating a young adult. This happens mostly due to lower immunity and other comorbidities in old age. As the sciences are advancing, the treatment is more inclined toward the curative element rather than just providing symptomatic relief to geriatric patients with cancer.
Geriatric assessment provides a complete profile of such patients before even starting the actual treatment. This assessment comprises the various assessment tools based on which treatment plan is carried out for such patients.
How Does Frailty Affect Cancer Prognosis for Geriatric Patients?
Old age may often lead to frailty. A frail elderly person is characterized by many comorbid conditions that render them more susceptible to toxicity from therapy, has gait difficulties, low grip strength, and reduced cognition. Hence, it becomes necessary to thoroughly examine the patient and categorize them as fit or frail.
What Are the Tools of Geriatric Assessment?
Geriatric assessment has numerous criteria and tools on which they are assessed. They are
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Social status.
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Quality of life.
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Cognition.
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Nutrition.
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Medical management.
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Physiological status.
Assessment of Comorbidities - Understanding that comorbidities like diabetes, hypertension, and cardiovascular diseases may affect the treatment plan, action, and outcome of the treatment. The old age patients with underlying comorbidities are more prone to diseases and death due to cancer. While the action of treatment is directly dependent on these diseases, on the other hand, these conditions may deteriorate due to cancer itself.
Cognitive Assessment - With growing age, there is a decline in cognition. It has been reported that the treatment outcome in patients with undiagnosed dementia has a poor prognosis. The treatment outcome is compromised due to the inability to retain the treatment guidance or directions from the treating physician, non-compliance with medication due to dementia, and inability to recall events. Hence, a prior assessment of cognitive decline or dementia may help formulate the treatment plan accordingly, and it may also determine the prognosis of treatment.
Social and Economic Status Assessment - The socio-economic status of the geriatric patient plays a significant role in maintaining life quality and treatment efficacy. It ensures the patient's status with family, relatives, and society. The criteria enlist the affordability of the patient for the basic treatment or any need for a caretaker. By assessing the socio-economic status of the patient, the physician can give a tailored treatment plan that will be aimed at managing cancer in accordance with the patient's affordability and effectiveness. In case the patient is from a low economic status, the doctor might help to suggest and set up their basic insurance procedure for the betterment of the patient.
Nutritive Assessment - The nutritive assessment determines the intake of a healthy diet and calories of the patient. The treatment and the immunity are directly related to the nutrition intake by the patient. This also includes unexplained weight loss, which needs to be checked out prior to the treatment.
Geriatric patients may often experience weight loss due to treatment complications that arise from the adverse effects of chemotherapy or radiotherapy. Hence, a nutritive assessment is necessary to determine any change that may be required to be included in the diet for better treatment results. A discussion with a nutritionist can be helpful in these cases who can suggest a reasonable diet for such patients. As therapies knock out the immunity of patients taking them, a proportionate diet with immunity boosters and supplements can be helpful.
Functional and Physical Assessment - As the body grows frail in old age, functional and physical assessment deals with the ability of an individual to maintain gait and the extent to which one can carry day-to-day tasks independently. This assessment determines the grip strength and time taken to mobilize, get up, or settle down. This also helps in figuring out how well the treatment plan for such patients with cancer will work. The better the functional and physical assessment, the better the prognosis.
Psychological Assessment - It is often found that the patients who are diagnosed with cancer eventually end up in depression. The treatment outcome is better in the patients who do not give up on depression. An adjunct to cancer treatment is a psychological therapy that may be required in such patients so as to boost the treatment.
In other instances where the patient is predisposed to depression, the prognosis becomes challenging due to a lack of motivation and a pessimistic approach. Such patients are in need of complete Palliative support care that includes psychological, spiritual, and physical support. Giving a happy environment to such patients with the least possible moments of isolation can reverse the poignant factors.
Conclusion
Since geriatric assessment is very necessary and helps to maintain treatment efficacy and quality of life, timely and impactful examination of geriatric patients suffering from cancer should be done prior by treating physicians. This sets a provision for lifestyle and overall living of the patient with the disease. The goal is to minimize the adverse effects of treatment for geriatric patients in regard to the period one spends the rest of the life with the least possible effect on physical and mental well-being.
