|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 149-150
The real issue with geriatric oncology
Amish D Vora
H.O.P.E. Cancer Center, New Delhi, India
|Date of Submission||02-Jan-2020|
|Date of Acceptance||03-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Amish D Vora
H.O.P.E. Cancer Center, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vora AD. The real issue with geriatric oncology. Cancer Res Stat Treat 2020;3:149-50
The international medical community has traversed far to gain insights into the care of cancer in older patients. Frailty, cognitive impairment, accidents, comorbidity index, and comprehensive geriatric assessment (CGA) have all become common armamentarium when tackling the needs of older patients with cancer. Geriatric oncology has become a well-recognized medical superspecialty in the international arena.
However, there is a dearth of data on geriatric oncology from India. This was highlighted in 2006 by Arora et al. in a survey of 112 practicing oncologists, and since then, the lacunae in Indian reports have persisted till now. Even in 2019, the Indian Geriatric Oncology Society is still nonexistent. Guidelines adapted to Indian geriatric patients are still not formed and neither do we have CGA tools specific for the Indian scenarios.
And hence, I would wish to congratulate Noronha et al. for highlighting this issue, in the Indian context, for the reports of her recent survey. Pandey and Singh, in the accompanying editorial, have succinctly brought out the issue of limited clinical trial participation of older patients with cancer.
However, let us take a step back and ask ourselves, “What is the real issue? Why has India failed to recognize geriatric oncology as a separate subspecialty? Is it only India-specific?” I do not think so. Many countries in the world face similar predicaments. There are, not one, but a few issues at stake here. First and foremost, 'Geriatric Oncology' is not only 'Oncology in Geriatrics'. It is perhaps much more about the entirety of geriatrics with an additional problem in the form of cancer. We lack insights into how cancer, in an 80-year-old patient, would behave differently than in one whose age is 60. To give a few examples – would exon 19 mutation in non-small cell lung cancer confer the same predictions/prognostications, or would the next-generation sequencing signature of triple-negative breast cancer differ (even with the same phenotype), or would lapatinib cause more or less diarrhea – in these two populations (80-year-olds versus 60-year-olds) and why?
Second, CGA tools have not been shown to directly affect survivals. Is it possible that an older but physically fit patient (a regular gym enthusiast) may not require a CGA at all? On the other hand, if we show a correlation of CGA with even the progression-free survival, then the implications would be widely acceptable.
Finally, it is increasingly common to see cancers with similar biology across the ages. Moreover, in today's trend of Disease Management Groups (dedicated to cancers of only particular types – such as leukemias or sarcomas or gastrointestinal cancers), should geriatric oncology not be a subspecialty of each, rather than a superspecialty on it own? Every oncologist would probably require the skills of caring for older patients too.
To conclude, surveys, are a good start but are not solutions at all. The questions facing this nascent field of geriatric oncology are many and demand urgent attention. Noronha et al. perhaps can, and should, lead these frontiers, in addressing some of the above conundrums facing the geriatric oncology community of India.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Arora B, Parikh PM, Nair R, Vora A, Gupta S, Sastry P, et al
. Status of geriatric oncology in India: A national multicentric survey of oncology professionals. J Clin Oncol 2006;24 Suppl 18:16035.
Noronha V, Talreja V, Joshi A, Patil V, Prabhash K. Survey for geriatric assessment in practicing oncologists in India. Cancer Res Stat Treat 2019;2:232-6. [Full text]
Pandey A, Singh A. Treating the older patients with 'younger' evidence-based therapy: Time to tailor to suit the fragility. Cancer Res Stat Treat 2019;2:226-7. [Full text]
Clough-Gorr KM, Silliman RA. Translation requires evidence: Does cancer-specific CGA lead to better care and outcomes? Oncology (Williston Park) 2008;22:925-8.