Geriatric Oncology

Question 1

what is geriatric oncology

Answer 1

the management of older adults with cancer. it focuses on the unique needs of older adults with cancer, related not only to chronological age, but to the variations that may occur in presentations due to differing ageing processes

Question 2

what is ageing

Answer 2

ageing is a process that converts healthy adults into frail ones with diminished reserves in most physiologic systems and exponentially increasing vulnerability to most diseases and to death

Question 3

physiology of ageing

Answer 3

1. heterogenous process - happens at a very different pace in individuals
2. gradual declines in multiple organ function
3. body composition changes e.g. muscle replaced by fat
4. depletion of physiologic reserve
5. most evident under stress
6. systems slower to react and regain homeostasis
7. increased vulnerability (and frailty)

Question 4

what is frailty

Answer 4

1. decreased functional reserve
2. impairment or dysregulation in multiple physiological systems
3. reduced ability to regain physiological homeostasis after a stressful or destabilising event

Question 5

what are the two theories of frailty

Answer 5

1. phenotypic theory
2. accumulated deficits theory

Question 6

prevalence of frailty

Answer 6

• increased with age
• greater in women than in men
• associated with lower socioeconomic groups (low educational attainment or low income) and ethnic minorities (higher prevalence)

Question 7

frailty and long term cancer treatment outcomes

Answer 7

• increased healthcare utilisation
• long term functional outcomes
• long term care admissions
• cognitive decline
• poorer quality of life

Question 8

Phenotype of frailty (Fried Criteria)

Answer 8

Features:
1. unintentional weight loss >= 5% body weight in last year
2. exhaustion - self-report of fatigue or felt unusually tired or weak in the past month
3. weakness - grip strength (kg) for body mass index (kg/m^2)
4. slow walking speed
5. low physical activity
3-5=frail
1-2=intermediate (pre-frail)
0=not frail

Question 9

deficit frailty theory

Answer 9

• social support
• cognition
• comorbidities
• functional status
• polypharmacy
• nutrition
• psychological status

Question 10

what is comprehensive geriatric assessment

Answer 10

multidimensional, interdisciplinary diagnostic process focused on determining an older person’s medical, psychological and functional capacity in order to develop a coordinated and integrated plan for treatment and long term follow up - Rubenstein 1991

Question 11

evidence base for CGA in older patients with cancer

Answer 11

• to identify areas of vulnerability that may otherwise be missed in routine oncology visits
• can predict survival and adverse events of treatment to assist clinical decision making
• identifies areas where interventions can be performed, such as dietary advice, physical therapy, and social support, which can help patients tolerate and complete prescribed treatments
• improves post-operative survival
• guideline coordinate care
  (NCCN older adult oncology 2023)

Question 12

RCTs to show benefit of CGA

Answer 12

GAIN
INTEGRATE Qian et al.
GAP-70

Question 13

How is functional status assessed in oncology

Answer 13

ECOG
scores 0-5

Question 14

activities of daily living (ADLs) in geriatric medicine

Answer 14

bathing
dressing
toileting
transferring
continence
eating

Question 15

instrumental activities of daily living (IADLs) in geriatric medicine

Answer 15

use telephone
manage finances
shop
arrange transportation
housework
prepare meals
manage medications

Question 16

functional status objective physical performance

Answer 16

gait speed
falls risk

Question 17

falls risk

Answer 17

falls risk assessments important to prevent falls
leading cause of traumatic mortality in this age group
at least 10% of falls result in injuries, including head injuries and fractures
24% of >55year olds die within a year following a hip fracture
associated with subsequent fear of falling and functional decline

Question 18

cormorbidity

Answer 18

increased polypharmacy
increased risk of drug adverse effects
falls risk

Question 19

how is cognition relevant to RT

Answer 19

informed consent (capacity) - only the patient themself can give consent
compliance with procedural/treatment requirements
possibility of unknown cognitive issue

Question 20

Assisted Decision Making (capacity) Act 2015

Answer 20

• establishes a modern statutory framework to support decision-making by adults who have difficulty in making decisions without help, or may in the future
• provides for the individual’s right of autonomy and self-determination to be respected through an Enduring Power of Attorney and an Advance Healthcare Directive
• Abolishes the Wards of Court system (lunacy act)
• Importantly, the concept of “best interests” is not mentioned in the act, but rather, it is the “will and preferences”

Question 21

what is dementia

Answer 21

• a group of organic or physically based mental disorders that present with memory impairment and deficits in at least one cognitive domain
• include attention, orientation, judgement, abstract thinking and personality

Question 22

symptoms of demetia

Answer 22

aphasia - language impairment
amnesia - memory impairment
disorientation
apraxia - inability to carry out actions
agnosia - inability to recognise sensory perception
executive dysfunction - impaired judgement and inability to plan or carry out tasks

Question 23

environmental design principles for people with dementia

Answer 23

• colour contrast
• light and noise
• signage: signs should be easy to read. wall signs should be at eye level
• recognition
• safety: declutter, easy to operate doors

Question 24

what are BPSD

Answer 24

behaviours and psychological symptoms
behaviours:
- agitation
- aggression
- disinhibition
- shadowing
- sleep disturbance
- vocalisations
- wandering
psychological symptoms:
- delusions
- hallucinations
- irritability
- paranoia
- depression
- anxiety
- apathy