This content is adapted from a Cancer.Net podcast recorded in Spanish. This conversation has been edited for length and content.
Enrique Soto, MD, is a geriatric oncologist, which is a doctor who specializes in the care of older adults with cancer. He works at the Salvador Zubirán National Institute of Medical Sciences and Nutrition in Mexico City. Dr. Soto is a member of the Cancer.Net Editorial Board. Follow Dr. Soto on Twitter @EnriqueSoto8.
Geriatric assessments play an extremely important role in properly caring for older adults with cancer. Here, Dr. Soto talks about what geriatric assessments are and how they impact treatment for older adults with cancer.
Q: What is a geriatric assessment?
A: Geriatric assessments are a tool used in geriatric medicine, a field of medicine where doctors treat older adult patients. These assessments are used to evaluate patients using a multidisciplinary approach. This allows the doctor to know everything that happens with that person. It is a medical consultation that also takes into consideration factors that are particularly important for the care of older adults. This includes their ability to live their daily lives, physical ability, nutrition, different illnesses they may have, cognitive capacity and memory, psychological state, state of mind, and their access to social and financial support.
Through a series of questions, including questionnaires and tools that are designed for this purpose, you can evaluate all the relevant characteristics of older adults to get to a holistic understanding of the person. The evaluation allows you to find things that you might not find during a regular oncology consultation.
Q: Why is a geriatric assessment important for an oncologist to use while treating a person with cancer?
A: Normally, oncology evaluations include an evaluation of the person’s functional capacity, but they can be 1-dimensional and basic. That is not enough for older adults, as people who are aging are different. After a certain point, a person’s age does not tell us much about who they are and what is happening in their lives. We all know older people who are older than 70 or 80 who are very active and independent. We also know much younger people who need help with many things.
Evaluating a person’s activity level and independence is more important than their age, and we can evaluate this with a geriatric assessment. A geriatric assessment gives us a true biological age of a person. In oncology, this can help us predict life expectancy for patients and their risk of side effects from treatments, particularly chemotherapy. Through the geriatric assessment, we can find out if a person is feeling low, if they have problems walking, or if they need social support. We can help in these cases and improve the overall quality of life for these patients.
Q: How do geriatric assessment results affect the treatment a patient receives?
A: There are many ways that a geriatric assessment and the intervention of a geriatric oncologist or a geriatric physician can change or affect the patient’s treatment. The evaluation can help us discover additional vulnerabilities that you might not normally find during a normal clinical evaluation. This helps us make decisions about ways we can improve a patient’s problems.
For example, one important thing that a geriatric assessment predicts is how other illnesses a person might have will affect their cancer treatment, which in turn could affect their life expectancy. This can help doctors and patients make difficult decisions. Sometimes, treatments have risks that are worse than the risks of an illness. The geriatric assessment helps to keep this balance in perspective.
Q: What are some examples of other illnesses that can affect cancer treatment?
A: Cognitive problems, like dementia, can affect cancer treatment and are common in older adults. With the passage of time, many older adults develop memory and attention problems and a diminished capacity to make decisions. This is a big reason why a geriatric oncologist or geriatric physician might need to treat an older adult.
Another common problem that we keep in mind during oncology consultations is a history of falls. Older adults with cancer have a higher risk of falling. Falling can cause hip fractures, which can affect quality of life and even survival. Using a geriatric assessment to determine ahead of time that a patient may be at a higher risk of falls can help us avoid treatments that increase this risk. It can also help us to implement interventions to avoid falls, like installing railings in the home to help make it safer or doing physical or occupational therapy to reduce risk.
Q: What are other things older adults with cancer should do to make their homes safer?
A: In the United States, there are services that can help older adults improve their homes. In other parts of the world, this is not as common, but you can avoid having obstacles in the home. For example, avoid going up and down the stairs and use canes and walkers. It’s important to prescribe rehabilitation, which can help patients find the right type of walking aid. Improving nutrition and physical strength can also reduce the risk of falls. To achieve this, in many cancer centers, there are multidisciplinary teams that can help. Almost all the cancer centers in the United States have physical therapy and occupational therapy teams that can help.