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LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 189-190

Authors' reply to Radhakrishnan


Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Homi Bhabha National Institute, Mumbai, India

Date of Submission02-Mar-2021
Date of Acceptance02-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Vanita Noronha
Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Homi Bhabha National Institute, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_54_21

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How to cite this article:
Noronha V, Ramaswamy A, Gattani S, Prabhash K. Authors' reply to Radhakrishnan. Cancer Res Stat Treat 2021;4:189-90

How to cite this URL:
Noronha V, Ramaswamy A, Gattani S, Prabhash K. Authors' reply to Radhakrishnan. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:189-90. Available from: https://www.crstonline.com/text.asp?2021/4/1/189/312114



We appreciate the comments of Dr. Radhakrishnan[1] regarding our article on, “Ethnocultural inequity in the geriatric assessment.”[2] We agree that the biological age of the patient is far more important than the chronological age. Indeed, the value of the geriatric assessment is to detect frailty in persons regardless of their chronological age. Should a geriatric assessment be performed in people who are chronologically below the age of 60 years but appear to be older? The principles of the geriatric assessment are broad, and the goal includes the detection of vulnerabilities in various non-oncologic domains, such as nutrition, physical function, falls, depression, anxiety, cognition, comorbidities, and social support. These domains may certainly be deranged in a person of any age and should ideally be assessed, if suspected to be abnormal, in a patient of any age. Assessing a person who does not know his/her date of birth is challenging. We attempt to estimate the person's age by discussing the issue with the patient and the family and evaluating the official documents like the government-issued Aadhar card, if available. Assessment of frailty through the measurement of inflammatory cytokines and biomarkers holds promise, but needs to be validated.[3]

We agree on the need for validated short screening tools as a means to determine which patients need a full geriatric assessment. In our geriatric oncology clinic at the Tata Memorial Hospital in Mumbai, India, we perform various short screening tests including the G8, VES-13, and TRST, but proceed with the full geriatric assessment in all patients.[4] We do this in order to help us understand whether these screening tools can accurately predict for the presence of frailty on the geriatric assessment in our older Indian patients with cancer as well as whether they independently predict for mortality. We are also in the process of evaluating the ideal cut off scores on the G8 and VES-13 scales for our patients.

We completely agree with Dr. Radhakrishnan that as physicians, our judgment regarding patient frailty is often flawed, especially in older adults with cancer, and that the use of validated geriatric assessment tools improves patients' outcomes.[5] We also agree regarding the need for more research and outcomes data from our Indian patients with cancer.[6] This was the reason behind starting the geriatric oncology section in the Cancer Research Statistics and Treatment Journal, which will hopefully stimulate the collection and publication of such data.

The problem of families taking decisions for the patient is not unique to older Indian patients, rather it appears to be a cultural issue that cuts across age lines.[7] This is a complex situation and one that requires finesse to resolve. We approach such situations on a case-by-case basis. Although the patient's wish is paramount, we also take into consideration the suggestions of the caregivers. We follow various set guidelines, including the question prompt list and try to attend communication skills training workshops to enhance our communication and empathetic skills.[8],[9],[10]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Radhakrishnan V. Old is always not gold in geriatric oncology assessment. Cancer Res Stat Treat 2021;4:188-9.  Back to cited text no. 1
  [Full text]  
2.
Noronha V, Ramaswamy A, Banavali S, Gattani S, Prabhash K. Ethnocultural inequity in the geriatric assessment. Cancer Res Stat Treat 2020;3:808-13.  Back to cited text no. 2
  [Full text]  
3.
Hubbard JM, Jatoi A. Incorporating biomarkers of frailty and senescence in cancer therapeutic trials. J Gerontol A Biol Sci Med Sci 2015;70:722-8.  Back to cited text no. 3
    
4.
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. 4
  [Full text]  
5.
van Walree IC, Scheepers ER, van den Bos F, van Huis-Tanja LH, Emmelot-Vonk MH, Hamaker ME. Clinical judgment versus geriatric assessment for frailty in older patients with cancer. J Geriatr Oncol 2020;11:1138-44.  Back to cited text no. 5
    
6.
Noronha V. Making a case for cancer research in India. Cancer Res Stat Treat 2018;1:71-4.  Back to cited text no. 6
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7.
Chandrasekharan A. A tale of two patients. Cancer Res Stat Treat 2020;3:1-2.  Back to cited text no. 7
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8.
Chittem M, Maya S. A twist in the tale: Alternate methods to communicate, or are they great expectations? Cancer Res Stat Treat 2020;3:360-1.  Back to cited text no. 8
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9.
Thomas VM, Mathew A. Truth-telling: Apply the principle of beneficence. Cancer Res Stat Treat 2020;3:359-60.  Back to cited text no. 9
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10.
Konstantis A. Breaking bad news and autonomy of cancer patients. Cancer Res Stat Treat 2020;3:362.  Back to cited text no. 10
  [Full text]  




 

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