(UroToday.com) The 2023 ASCO annual meeting included a session on the management of prostate cancer in older adults, featuring a presentation by Dr. Elizabeth Kessler discussing assessment and decision tools for balancing survival and quality of life. Dr. Kessler started her presentation by posing the question: Do we want to live longer or live better? There are several goals of concordant care:
- Care that aligns with patient values and priorities
- Care the accounts for physical and emotional health of the patient
- Care that is decided upon together
The elderly population is a unique population given that since 2010, the incidence of cancer is increasing to the point that 67% of patients >65 years of age will develop cancer:
It is important to understand this population. Specifically, we must balance life expectancy with disease trajectory and assess the risk of toxicity in balance with evidence of treatment benefit. Indeed, the traditional older cancer patient has several common characteristics:
- Has a few other medical problems
- Has a fixed income
- Has a memory that is good, but not great
- Can drive himself, but his kids don’t want him to drive the distance to your clinic since it can be busy/long
- Is considering his cancer diagnosis amidst his other health conditions and doesn’t want to be a burden to others
Informed care is crucial for elderly patients. For prostate cancer patients, for example, in a 75 year old patients, he should be managed according to his individual health status, not his age, particularly if they are vulnerable or frail:
Dr. Kessler emphasized that in these elderly patients, it is crucial to perform a geriatric assessment in order to optimize a patient care plan. This geriatric plan incorporates many different aspects of the patient’s life:
The benefits of a geriatric assessment include (i) reducing toxicities of treatment and reducing hospitalizations and length of stay; (ii) increased referrals to supportive care services and improved quality of life. In the ASCO assessment and management of vulnerabilities in older patients receiving chemotherapy, an ASCO survey on the geriatric guidelines revealed that:
- 75.2% of respondents didn’t know tools existed
- 73% didn’t know which tool to use
- 76.4% didn’t have the training to use the tools
Dr. Kessler notes that there are several ways to perform a screening evaluation, including paper, self-administration, electronic, and a clinical interview. Several tools include ePrognosis, miniCOG, and the G8 assessment. Including geriatric assessments in oncology clinical visits for older adults with advanced cancer improves patient-centered and caregiver-centered communication about aging-related concerns.
Dr. Kessler concluded her presentation discussing assessment and decision tools for balancing survival and quality of life by emphasizing that these tools and assessments are the starting point to guide “intervention”. We need to focus on communication, supportive measures, and care plan adjustment.
Presented by: Elizabeth R. Kessler, MD, University of Colorado Cancer Center Anschutz Medical Campus, Aurora, CO
Written By: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, Fri, June 2 – Tues, June 6, 2023.