|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 188-189
Old is always not gold in geriatric oncology assessment
Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
|Date of Submission||24-Jan-2021|
|Date of Decision||05-Feb-2021|
|Date of Acceptance||11-Feb-2021|
|Date of Web Publication||26-Mar-2021|
Professor, Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Radhakrishnan V. Old is always not gold in geriatric oncology assessment. Cancer Res Stat Treat 2021;4:188-9
Noronha et al. in their review have highlighted the problems of using geriatric assessment scales developed in the high-income countries (HICs) for patients with cancer in the low- and middle-income countries like India. Even though the geriatric assessment tools developed in HICs are gold standards in these countries, they cannot be extrapolated to the Indian scenario.
A unique problem that the oncologists face in the clinics, in addition to the social, cultural, and economic issues raised by Noronha et al., is the difference between the chronological age and biological age of the patients. Many patients are chronologically in their late 40s and 50s, but biologically appear to be in their 60s or 70s. Should these patients be excluded from the geriatric assessment because they do not meet the cutoff age of 60 years? It is not uncommon to see patients who do not know their date of birth and therefore their age. How should we account for these patients in our assessment? It has been observed that women with biological age (quantified using DNA methylation) greater than their chronological age have an increased risk of developing breast cancer. Biological aging is characterized by epigenetic alterations and mitochondrial dysfunction. Clinically, the biological age of an individual is estimated by assessing frailty, which is a part of many geriatric assessment scales. It would be interesting to see if a lab-based molecular assessment of frailty is more accurate than a clinical assessment.
A comprehensive geriatric assessment takes approximately an hour, and most cancer centers in India can only offer patient consults for <10 min per patient due to the large patient numbers. Therefore, such assessments might not be feasible in the Indian clinics. Hence, we need short and locally adapted screening geriatric questionnaires that can be administered in 5 min and a more detailed assessment for patients identified as being at high risk in the screening questionnaire. The detailed assessment should also not exceed 30 min, as anything longer than this would make it less attractive for use in clinical practice. A study from the All India Institute of Medical Sciences, New Delhi, recently tried to bridge this gap.
There is a paucity of data from India on the outcomes in geriatric oncology. When we assessed our cohort of older patients with lymphoma, we observed that most of the clinical decisions regarding the choice of chemotherapy regimens and dose adjustments were based on the subjective assessments of the physician rather than an objective geriatric assessment. With subjective assessments, there is a risk of either undertreating or overtreating a patient.
Another challenge that I faced in my clinical practice is that older patients are not given the autonomy to make decisions regarding their treatment. Many families insist that the diagnosis of cancer should not be shared with their patients, as they feel that the knowledge about their diagnosis may cause so much trauma as to kill the patient's spirit. The questions asked to the patients are also mostly answered by the caregivers. In such situations, it becomes challenging to perform a geriatric assessment as the patient is not aware of the diagnosis and the response to the questions in the assessment is given by the caregiver.
Therefore, the time is ripe to design a local geriatric assessment tool for older Indian patients with cancer.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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