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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 1 | Page : 150-151 |
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Geriatric oncology in India: An unmet need
Annu Rajpurohit
Department of Medical Oncology, Tata Memorial Hospital; Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| Date of Submission | 05-Jan-2020 |
| Date of Acceptance | 06-Jan-2020 |
| Date of Web Publication | 24-Feb-2020 |
Correspondence Address:
Annu Rajpurohit
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/CRST.CRST_12_20
How to cite this article:
Rajpurohit A. Geriatric oncology in India: An unmet need. Cancer Res Stat Treat 2020;3:150-1 |
We are living in an age when the population in the developing countries is rapidly ageing due to increase in life expectancy as a result of improving health care. It is predicted that population above the age of 60 years would increase by 102% by 2021 as compared to that of 2001.[1] It is also a well-established fact that the incidence of cancer is up to 11 times higher in people above the age of 65 years as compared to the younger population.[2] The exact reason for this higher incidence is not clearly established; however, it is expected to be multifactorial with some of the factors being defective DNA repair, immunological ageing, oncogene activation due to piling up of random somatic/genetic mutations, prolonged carcinogenic exposure, and changes in hormonal milieu.[3] Thus, it should be emphasized here that every oncologist should be trained in Geriatric Oncology as a significant number of patients in oncology belong to the age group over 60 years.
Geriatric oncology patients are prone to develop severe toxicities in view of multiple comorbidities and polypharmacy. Furthermore, the majority of the clinical trials exclude geriatric patients. This, in turn, leads to availability of little data for geriatric patients, and thus, the management of geriatric patients requires significant expertise and attention to cater to individual patients. Most of the time, the data of fit, young patients need to be extrapolated to this population which may lead to poor outcomes and increased toxicities. The American Society of Clinical Oncology (ASCO) recommends that all geriatric oncology patients should undergo an assessment of various geriatric domains, including social support, physical function/falls, cognition, nutrition, medications, comorbid medical disorders, and depression. Despite these special needs, geriatric oncology as a subspecialty of oncology is still in primitive stages of development in India. This is reflected by the survey by Noronha et al.[4] In this survey, majority of the respondents (70%) admitted that they do not apply any specific tools in the assessment of their geriatric patients. Besides, 44% were unaware of the ASCO Geriatric Oncology Guidelines Practical Assessment and Management of Vulnerabilities in older patients receiving chemotherapy.
The editorial accompanying this article highlights the important points related to the above survey.[5] The lack of awareness of geriatric oncology tools has been found to be widely prevalent among Indian oncologists. In addition, comprehensive geriatric assessment (CGA) as a means to understand and document the vulnerabilities of geriatric patients has been limited due to complexities and time requirement to assess the multiple CGA domains. The time required to perform CGA is often as long as one hour which is definitely not possible with constraints of limited task force and poor oncologist-patient ratio in government hospitals in India. Multiple attempts have been made to make CGA more doctor–friendly; some of these include simplifying the CGA by administering abbreviated forms of CGA or using CGA mailed to the well-educated patients and electronic CGA. However, it should be borne in mind that these altered forms of CGA have not yet been validated in prospective cohorts.
It should be kept in mind that the age cutoff for geriatric population in the Western literature is often taken as 65 years, while in developing countries with lower life expectancy and poorer health care infrastructure, the cutoff for geriatric population should be lower. Further surveys should include question about age cutoff used by the oncologists around the country. Furthermore, instead of adapting from the studies of the West, the studies should focus on this issue of lower age cutoff needed for geriatric population in our settings. Besides, there is need of modifying the various cognition assessment tools so that they can take into account illiterate patients as well. This specific need arises in developing countries with significant proportion of the population being illiterate and the prevailing tools requiring reading, writing, and drawing clock which is not feasible in illiterate geriatric patients.
In summary, there is an unmet need to cater to geriatric patients in oncology, and the treating oncologists should make an effort to incorporate some of the important tools in daily practice while dealing with geriatric patients. At the same time, research to improve and adapt the tools for geriatric assessment in Indian settings should be conducted.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Census of India. Population Projection for India and States 2001-2026. Census of India; 2001. p. 139-40.  |
| 2. | Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, et al. (eds). SEER Cancer Statistics Review, 1975-2001, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2001/, 2004. |
| 3. | Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, et al. Developing a cancer-specific geriatric assessment: A feasibility study. Cancer 2005;104:1998-2005. |
| 4. | 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] |
| 5. | 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] |
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