Geriatric assessment in older patients with cancer: a new standard of care
Mené aux Etats-Unis sur 718 patients atteints d'un cancer de stade avancé et âgés de plus de 70 ans (âge moyen : 77,2 ans), cet essai randomisé analyse l'intérêt d'une évaluation gériatrique pour réduire la toxicité des traitements anticancéreux
Advanced cancer mostly affects older adults, and the dilemma of how to best treatolder patients with cancer led to the emergence of geriatric oncology over 25 yearsago. Early studies showed the heterogeneity in the older population and highlightedthat frailty is insufficiently captured in a standard oncological work-up. Adopting geriatric assessment—a multidimensional assessment of health status acrosssomatic, functional, and psychosocial domains, which is routinely used in geriatricmedicine—led to studies consistently showing an association between geriatric impairments,frailty, and various adverse outcomes, including complications, toxic effects, andmortality across various cancer and treatment types. Subsequent research showed that pre-treatment geriatric assessment influenced treatmentdecisions in older adults with cancer and could guide non-oncological management. Despite these emerging data, implementation of geriatric assessment into clinicalpractice has been slow. A possible explanation could be insufficient evidence showing that geriatric assessment-adaptedoncological care leads to improvements in outcomes that are meaningful to both patients and clinicians.
The Lancet , commentaire, 2020