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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 659-660

Next steps for geriatric oncology in India


H.O.P.E. Oncology Clinic; Department of Medical Oncology, PSRI Hospital, New Delhi, India

Date of Submission02-Jul-2020
Date of Decision07-Jul-2020
Date of Acceptance16-Jul-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Amish D Vora
H.O.P.E. Oncology Clinic, New Delhi; PSRI Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_231_20

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How to cite this article:
Vora AD. Next steps for geriatric oncology in India. Cancer Res Stat Treat 2020;3:659-60

How to cite this URL:
Vora AD. Next steps for geriatric oncology in India. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 28];3:659-60. Available from: https://www.crstonline.com/text.asp?2020/3/3/659/295559



I sincerely congratulate Noronha et al. for publishing the first-ever experience of a geriatric oncology clinic from India.[1] As suggested in the accompanying editorial by Parikh et al., the growing number of older patients with cancer in India makes it necessary for every cancer center to have a dedicated geriatric oncology outpatient department.[2],[3] We live in the era of patient centric or personalized cancer care. Therefore, it is essential to recognize and possibly rectify the existing cognitive deficit in all geriatric patients to make “informed decision-making” a reality.

Spurred by this excellent initiative from Noronha et al., I would like to highlight the key points in geriatric oncology that are critical to the way forward:

  1. Collateral history: As reported by Kukreja et al., the prevalence of delirium in older patients in India ranges from 25% to 54%.[4] Furthermore, the authors believe that this prevalence is underreported. If these numbers are to be believed, at least a third of our older patients with cancer could be suffering from delirium. This will preclude them from thoroughly understanding their condition and hence from making the right decisions for themselves. For instance, an older woman suffering from delirium/dementia may not be able to completely comprehend the importance of a sentinel lymph node biopsy, and thus, may end up with lymphedema due to axillary lymph node dissection, which could otherwise be avoided by incorporating the collateral history. Did Noronha et al. include the collateral history and document its details? A separate form for collateral history should be accessible from centers practicing geriatric oncology, after adequate validation[5]
  2. Integrated oncogeriatric care: A comprehensive geriatric assessment (CGA) done only once, without the documentation of follow-up or interventions thereof, would be, albeit a good start, of limited significance in the treatment of older patients with cancer. Credit is due to Noronha et al. for spearheading in the right direction, because CGA in itself is a mammoth task. Moving forward, I would suggest that they consider intervention-led oncogeriatric care to improve the deficits noted in the various domains of CGA to improve the outcomes in these patients, as shown by the Australian group in ASCO 2020.[6] With the advantages of the support and strengths of their establishment, Noronha et al. are best placed to bring this to fruition, and not doing so would be an opportunity lost
  3. The authors have used the Cancer and Aging Research Group (CARG) tool for assessing the chemotoxicity, as developed by the late Dr. Arti Hurria and Dr. Supriya Mohile.[7] In CARG, there is an option for monotherapy as well as dose reductions. An interesting paper was presented by Hall et al. in ASCO 2019.[8] In their randomized study (advanced gastroesophageal cancer), they reported that reduced doses of the combination of capecitabine with oxaliplatin resulted in non-inferior outcomes, with better quality of life in older frail patients with gastroesophageal junction cancers. Using these proven principles of geriatric oncology care, if Noronha et al. incorporate a toxicity based chemodose reduction strategy, as per the CARG tool, and document the resultant impact on the outcomes in the Indian population, the geriatric oncology field in India would be considerably benefited. This is especially relevant because, as reported by Noronha et al., malnutrition was common in their study group and chemotolerance is directly impacted thereby.


To reiterate, I commend Noronha et al. for this much needed initiative of a geriatric oncology clinic in India, but as a friend and a kind critic, I coax them to do more.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Noronha V, Ramaswamy A, Dhekle R, Talreja V, Gota V, Gawit K, et al. Initial experience of a geriatric oncology clinic in a tertiary cancer center in India. Cancer Res Stat Treat 2020;3:208-17.  Back to cited text no. 1
  [Full text]  
2.
Parikh PM, Chaitanya K, Boppana M, Kumar MS, Shankar K. Geriatric oncology landscape in India – Current scenario and future projections. Cancer Res Stat Treat 2020;3:296-9.  Back to cited text no. 2
  [Full text]  
3.
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.  Back to cited text no. 3
  [Full text]  
4.
Kukreja D, Günther U, Popp J. Delirium in the elderly: Current problems with increasing geriatric age. Indian J Med Res 2015;142:655-62.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Dyer AH, Foley T, O'Shea B, Kennelly SP. Cognitive assessment of older adults in general practice: The collateral history. Ir J Med Sci 2018;187:683-7.  Back to cited text no. 5
    
6.
Hurria A, Mohile S, Gajra A, Klepin H, Muss H, Chapman A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol 2016;34:2366-71.  Back to cited text no. 6
    
7.
Soo W, King M, Pope A, Parente P, Darzins P, Davis ID. Integrated geriatric assessment and treatment (INTEGERATE) in older people with cancer planned for systemic anticancer therapy. J Clin Oncol 2020:15 Suppl: 12011.  Back to cited text no. 7
    
8.
Hall PS, Swinson D, Waters JS, Wadsley J, Falk S, Roy R. Optimizing chemotherapy for frail and elderly patients (pts) with advanced gastroesophageal cancer (aGOAC): The GO2 phase III trial. J Clin Oncol 2019;37:4006.  Back to cited text no. 8
    




 

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