|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 189-190
Authors' reply to Radhakrishnan
Vanita Noronha, Anant Ramaswamy, Shreya Gattani, Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Homi Bhabha National Institute, Mumbai, India
|Date of Submission||02-Mar-2021|
|Date of Acceptance||02-Mar-2021|
|Date of Web Publication||26-Mar-2021|
Department of Medical Oncology, Tata Memorial Hospital, Maharashtra, Homi Bhabha National Institute, Mumbai
Source of Support: None, Conflict of Interest: None
|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
We appreciate the comments of Dr. Radhakrishnan regarding our article on, “Ethnocultural inequity in the geriatric assessment.” 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.
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. 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. We also agree regarding the need for more research and outcomes data from our Indian patients with cancer. 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. 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.,,
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Conflicts of interest
There are no conflicts of interest.
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