Senior adult oncology clinical practice guidelines in oncology

Because aging is highly individualized, the best guide as to whether cancer treatment is appropriate may be provided by careful assessment of the older patient (see page 574). Screening can be used to identify patients who can benefit from a comprehensive assessment (i.e., CGA). Chronologic age is not reliable in estimating life expectancy, functional reserve, or the risk of treatment complications. Careful assessment, using the criteria described in this NCCN Senior Adult Oncology guideline, allows oncologists to divide older patients into three groups as follows: (1) patients who are functionally independent (i.e., ADL and IADL independent) and without comorbidity and, thus, are candidates for most forms of standard cancer treatment; (2) patients with major functional impairment and/or complex comorbidity (i.e., dependent in one or more ADL with severe comorbidity or advanced geriatric syndromes [such as severe dementia]) who are candidates only for palliative treatment; and (3) patients with intermediate functional impairment (i.e., in between groups 1 and 2) who cannot tolerate life-prolonging curative therapy but who may benefit from some special pharmacological approach (such as reduction in the initial dose of chemotherapy with subsequent dose escalations as tolerated). All three groups of patients are expected to die of cancer or experience complications within their lifetimes (see page 574). A fourth group of patients includes those whose life expectancy is so short that they are unlikely to develop morbidity from cancer; these patients can receive symptom management and supportive care (see NCCN's Supportive Care Guidelines). Elderly patients who are deemed able to tolerate curative treatment have special needs. In general, age is not a primary consideration for surgical risk. However, concurrent radiation therapy/chemotherapy should be used cautiously; dose modification of chemotherapy may be necessary. Chemotherapy can lead to problems (such as neurotoxicity, cardiac toxicity, mucositis) that can be decreased or prevented by using specific recommendations from the NCCN Senior Adult Oncology Guideline (see page 576).