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APCCC 2019: The Aging Population: Onco-geriatric Assessment and Treatment Considerations

Basel, Switzerland (UroToday.com) Dr. Joe M. O’Sullivan spoke on the aging population and how to properly assess them in the context of prostate cancer. Life expectancy has been consistently rising since 1950 and is expected to continue to rise in 2050 (figure 1). The age at diagnosis of prostate cancer is shown in figure 2 and has been increasing over time, while prostate cancer mortality has been decreasing.

Figure 1 – Life expectancy through the years in various parts of the world:

Life Expectancy at Birth by Region

Figure 2 – Prostate cancer age at diagnosis:

Prostate Cancer Age at Diagnosis

Aging is associated with increased comorbidities, which may affect the tolerance of therapies for prostate cancer. It is also unclear to what extent do trial results apply to older patients, as they are significantly underrepresented in these trials, as can be seen in Table 1. Lastly, it is also important to consider the cognitive impairment and consent issues that are associated with aging, however, age alone should not determine how we treat patients.

Table 1 – Metastatic hormone-sensitive prostate cancer trials and age:

Metastatic Castration Sensitive Prostate Cancer Trials and Age

The international society of geriatric oncology (SIOG) has had a series of taskforces since 2010 and have formed guidelines for the assessment of elderly patients. Some of the recommended tools to assess elderly patients include the G8 screening tool, which is composed of 8 components covering food intake, weight loss, body mass index, mobility, neuropsychological problems, polypharmacy, self-perceived health status, and age. Another tool is the Mini-Cog screening tool, which is more practical than the mini-mental state examination. A cutoff point of 3/5 indicates a need to refer the patient for full valuation of potential dementia. These tools should be used in the clinic to assess elderly patients.

In summary, it is important to manage patients according to individual health status. Physicians should use tools to assess older patients:

  • If they are fit – they should be treated according to the standard protocol.
  • If they are vulnerable – they may have reversible issued that can be corrected.
  • If they are frail – The treatment needs to be modified accordingly.
Dr. O’Sullivan concluded his talk stating that we need to consider age profiles when developing trial protocols, to make sure that elderly patients are appropriately represented in all clinical trials.

Presented by: Joe M. O’Sullivan, MD, Clinical Director of Oncology at the Cancer Centre at Belfast City Hospital, Northern Ireland Cancer Center, Belfast

Written by: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, New York, USA @GoldbergHanan at the 2019 Advanced Prostate Cancer Consensus Conference (APCCC) #APCCC19, Aug 29 - 31, 2019 in Basel, Switzerland

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