The aging of the population will be a significant health problem in the coming years1.
It has to be pointed out that the changes associated with aging are variable in different individuals, and may not be parallel with that of chronological age. Thus, the determination of physiological age gives a better knowledge of mortality risk, by evaluating the susceptibility to stress and functional dependence2,3.
The Comprehensive Geriatric Assessment (CGA), includes the analysis of the physical status, morbidity, nutritional state, geriatric syndromes, and social support, and is the best validated tool for this purpose.
It is a multidimensional and multidisciplinary diagnostic process, to determine the medical, physiological and functional capacities of a fragile elderly person, with the aim of developing a coordinated and comprehensive plan for long-term treatment and follow-up. It emphasises the quality of life and functional status. The Comprehensive Geriatric Assessment is a dynamic process, since it is performed repeatedly over time to establish the progress of the patient and to assess the therapeutic measures applied. Its aim is the preparation of a comprehensive, individualised, diagnostic, therapeutic and follow-up plan4.
Its main features are, the use of interdisciplinary teams and standardised assessment tools5.
One of the aims of the treatment in the elderly is to extend the "active" life expectancy, which involves, besides curing, an increase in life-span, along with palliative treatment of the symptoms.
One particular problem associated with the management of elderly patients is the presence of intercurrent diseases, and pharmacological interactions between the drugs prescribed for the treatment of these diseases6. The management of the complexity is the main skill in the medical care of the elderly, with the choice of treatment being based on objective data7.
In 2011, cancer was the second cause of death in the general population and in people over 79 years in Spain, with tumours being the first cause of death between 40 and 79 years8. Due to the aging of the population, it is likely that cancer incidence will increase in the coming years.
The impact of the Comprehensive Geriatric Assessment within the framework of geriatric oncology is not clearly defined, but it is highly recommended to implement it before making a decision on the treatment in patients with cancer and advanced age9.
The International Society of Geriatric Oncology Chemotherapy has prepared several guidelines to improve the treatment and care in elderly patients with cancer, which may help health care professionals in the decision-making process10.
2.- Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA. 2012;307(2):182-192.
3.- Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, Levine RM, Lubiner ET, Reyes P, Schreiber FJ 3rd, Balducci L. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118(13):3377-3386.
4.- Rubenstein LZ. An overview of comprehensive geriatric assessment: rationale, history, program models, basic components. In: Rubenstein LZ,Wieland D, Bernabei R, eds. Geriatric Assessment Technology: The State of the Art. New York, NY: Springer; 1995. Osterweil D, Brummel-Smith K, Beck JC, eds. Comprehensive Geriatric Assessment. New York, NY: McGraw Hill; 2000.
5.- Wiland D, Kramer BJ, Waite MS, et al. The interdisciplinary team in geriatrics. Am Behav Sci. 1996;39:655-664.
6.- Larsen MD, Rosholm JU, Hallas J. The influence of comprehensive geriatric assessment on drug therapy in elderly patients. Eur J Clin Pharmacol. 2013 Nov 6. [Epub ahead of print]
7.- Marchesi F, Cenfra N, Altomare L, Dessanti ML, Mecarocci S, Cerchiara E, Rago A, D'Andrea M, Tomarchio V, Olimpieri OM, Tirindelli MC, Mengarelli A, Petti MC, Avvisati G, Cimino G.A retrospective study on 73 elderly patients (>75years) with aggressive B-cell non Hodgkin lymphoma: clinical significance of treatment intensity and comprehensive geriatric assessment. J Geriatr Oncol. 2013;4(3):242-248.
8.- Instituto Nacional de Estadística. http://www.ine.es
9.- Giantin V, Valentini E, Iasevoli M, Falci C, Siviero P, De Luca E, Maggi S, Martella B, Orrù G, Crepaldi G, Monfardini S, Terranova O, Manzato E. Does the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial. J Geriatr Oncol. 2013;4(3):208-217.
Beatriz Cuevas Ruiz MD, PhD
Department of Hematology and Hemotherapy
Hospital Universitario de Burgos
Mail: bcuevas @ hubu.es