Cancer treatment in the elderly should not focus only on tumor and survival

Faced with an increasing population aging in the world, the incidence of tumors in the elderly increases and the demand for oncogeriatric assessments is intensified, which calculate the risk-benefit ratio of cancer treatment considering aspects such as comorbidities, cognition and functional capacity of each individual.

The topic was presented this Tuesday (27) by hematologist Tathiana Braz, a postgraduate in oncogeriatrics at Hospital Albert Einstein and in palliative care at Instituto Pallium Latinoamérica, during the 9th Todos Juntos Contra o Câncer Congress, an event promoted by Abrale (Association Brazilian Society of Lymphoma and Leukemia). The panel was mediated by the oncology nurse Thais Gambarini and organized by the Instituto Oncoclínicas.

The higher incidence of cancer in this population occurs because longevity can mean a longer contact with triggers for tumors, such as smoking, physical inactivity and exposure to ultraviolet rays, for example. Thus, in addition to the natural process of senescence —a set of alterations common to the aging of the organism, such as loss of muscle mass—, in some cases, there are also the consequences of senility, related to chronic diseases.

Because it is diverse, the elderly population requires individualized oncological and geriatric assessments before prescribing a treatment, says Braz. People of similar ages can present different states of health and, therefore, recommendations should always be made based on information obtained by the medical team through patient analyzes in the office.

One of them, the AGA (Ample Geriatric Assessment), considers, in addition to the clinical picture (age, presence of comorbidities, use of medications, physical resistance, balance and stage of cancer), psychological and socioeconomic aspects of the patient, such as the development of depression. in old age and the support of friends and family.

Therefore, more factors are observed than in the oncological evaluation, to understand the responsiveness to treatment and tolerance to side effects. With these parameters, it is possible to try to predict the response of the organism when it is decided that the best path is a certain treatment, such as chemotherapy, and the life expectancy of the elderly according to their health conditions.

When the cancer patient is elderly, the focus should not be on the tumor and survival, but on the person and their quality of life. Braz exemplifies that, in a “robust” individual, in good health, it is possible to continue with a conventional treatment against cancer. In elderly people with some degree of frailty, the approach should be personalized. When the person is dependent, early palliative care is initiated.

In addition to these criteria, it is essential to listen to the patient’s opinion, since the concept of quality of life is subjective and may vary according to the view of the medical team, family members and the person himself.

In order for oncogeriatrics to advance, Braz says that it is necessary to include elderly people in clinical research, especially those with more complex health conditions, since today oncological guidelines focus only on cancer and this limits the application of protocols in people with comorbidities. The specialist adds that it is necessary to promote continuing education among health professionals so that oncogeriatric assessments are increasingly valued and implemented.