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 Elderly patients who are frail or who have multiple health
conditions may not be able to handle aggressive cancer treatment,
but aggressive treatment may be the best course for healthier older
patients, the guideline authors write January 11 in European
Urology.
“If the health status of the patient is okay, the treatment of
elderly patients is basically the same as their younger
counterparts,” said lead author Dr. Jean-Pierre Droz of
Claude-Bernard Lyon 1 University in France.
“There is no real difference in the approach, however, there are
adaptations of treatment based on the patient’s health status,” Dr.
Droz told Reuters Health by email.
To update the Society’s 2014 guidelines for treating elderly
prostate cancer patients, the task force reviewed articles published
between 2013 and 2016 on treatment of prostate cancer patients over
age 70 and each member proposed guideline changes. The results
represent their consensus.
The first recommendation is that doctors should decide the treatment
of an older patient based on the man’s individual health status and
not according to his age.
Elderly patients should be treated like younger patients if they
meet certain standards of health, including considerations of
physical fitness, nutrition and other health conditions, they write.
The authors recommend assessing each patient with what’s known as
the G8 screening tool, which covers food intake, weight loss, body
mass, mobility, neurological issues, medications, health status and
age.
If the G8 produces an abnormal result, further evaluations should
take into account whether patients have other health conditions, can
perform basic daily activities and if they have had any recent
unintentional weight loss.
Healthy patients should be able to tolerate any standard treatment,
while patients considered frail must receive treatment to try to
reverse their impairments before they can receive standard cancer
therapies, according to the authors.
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Patients with untreatable health problems should receive treatment
for their symptoms and may be able to handle adapted cancer
treatments.
Doctors should also screen patients for mental impairments during
the first evaluation to determine if they are able to make their own
treatment decisions.
“The patient’s decision is important and sometimes there are choices
which must be done because there are two different treatments which
are equivalent,” Dr. Droz noted.
Lastly, doctors deciding a treatment method must consider how severe
or advanced the prostate cancer is.
First treating a frail patient for reversible health problems can be
effective in helping them withstand the standard treatment given to
younger patients, said Dr. Joaquim Bellmunt, a researcher at the
Dana-Farber Cancer Center at Harvard University in Boston who was
not involved in the study.
There are a variety of factors doctors may want to consider in
treatment, he added. “Assessment of social situation, financial
resources, access to services, patient preference (in terms of goals
of therapy) are all relevant,” Dr. Bellmunt said by email.
“Elderly prostate cancer patients could receive the same treatment
as the younger patients but it may be adapted to their impairment or
health status,” Dr. Droz said. “Chronological age is not the most
important. What is important is health status.”
SOURCE: bit.ly/2iN9jUs
Eur Urol 2017.
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