|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 349-350
Author's reply to Sekhar
Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
|Date of Submission||09-May-2020|
|Date of Decision||11-May-2020|
|Date of Acceptance||11-May-2020|
|Date of Web Publication||19-Jun-2020|
Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pinninti R. Author's reply to Sekhar. Cancer Res Stat Treat 2020;3:349-50
I thank Dr. Sekhar for his valuable comments on the review article titled, “Management of geriatric cancer patients during coronavirus disease 2019 pandemic.”, With this reply, I would like to reiterate the importance of a comprehensive geriatric assessment (CGA) for clinicians taking care of geriatric oncology patients, to objectively assess the various functional domains, thereby mitigating the several inherent biases that may negatively impact the clinical outcomes in these patients., Once a CGA effectively clears the patients for consideration of cancer-directed therapy, there should be no room for ethical dilemmas regarding restrictions or modifications to therapy plans, withholding care, and consideration for palliative care based on the chronological age alone. If any such dilemma arises, it should not be unique to the older patients with cancer.
As mentioned in the review article, every attempt should be made to modify the cancer-directed therapy to limit the number of hospital visits, such as altered fractionated radiotherapy; oral substitutes, where feasible; and as suggested by the authors, extended schedule immunotherapy (either 4-weekly nivolumab or 6-weekly pembrolizumab)., However, care should be exercised to base such decisions on clinical evidence of non-inferior outcomes with modified therapy schedules, and clinicians should adhere to dosing as proposed in the regulatory approvals.
I agree with the author's assertion on the importance of general geriatric care in the form of seasonal flu and other vaccinations. This might help in reducing the background noise of other infections in this tumultuous period, where every minor lower or upper respiratory tract infection creates panic possibly leading to an emergency room visit and causes unnecessary exposure to the healthcare system, which is already burdened with the ongoing pandemic situation. As a result of the uncertain trajectory of the coronavirus disease 2019 (COVID-19) pandemic, all older individuals, particularly those with comorbidities, should be adequately informed about all the infection control measures, including vaccinations; however, these measures are a part of the standard geriatric medical care even during the nonpandemic clinical practice.
Despite years of neglect and exclusion from clinical trials, the time is ripe to address and emphasize the importance of inclusion of geriatric patients in several clinical trials trying to identify the “magic bullet” against COVID-19. As mentioned by the authors, several drugs and investigational therapies are being proposed,,, and the efforts should be made to involve the geriatric patients as a priority population for testing their safety and efficacy.
Finally, I agree with the author's observation of the greater psychological impact of the viral pandemic on the older patients. Clinicians and society at large should understand the true concept of “physical distancing,” which is not necessarily a social isolation, especially with regard to the older people. Digital technologies should be harnessed to reduce the disproportionately negative impact on the older patients due to the reduced access to physical and mental care during the ongoing pandemic.
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Conflicts of interest
There are no conflicts of interest.
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