Geriatric Oncology Flashcards
what is geriatric oncology
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
what is ageing
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
physiology of ageing
- heterogenous process - happens at a very different pace in individuals
- gradual declines in multiple organ function
- body composition changes e.g. muscle replaced by fat
- depletion of physiologic reserve
- most evident under stress
- systems slower to react and regain homeostasis
- increased vulnerability (and frailty)
what is frailty
- decreased functional reserve
- impairment or dysregulation in multiple physiological systems
- reduced ability to regain physiological homeostasis after a stressful or destabilising event
what are the two theories of frailty
- phenotypic theory
- accumulated deficits theory
prevalence of frailty
- 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)
frailty and long term cancer treatment outcomes
- increased healthcare utilisation
- long term functional outcomes
- long term care admissions
- cognitive decline
- poorer quality of life
Phenotype of frailty (Fried Criteria)
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
deficit frailty theory
- social support
- cognition
- comorbidities
- functional status
- polypharmacy
- nutrition
- psychological status
what is comprehensive geriatric assessment
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
evidence base for CGA in older patients with cancer
- 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)
RCTs to show benefit of CGA
GAIN
INTEGRATE Qian et al.
GAP-70
How is functional status assessed in oncology
ECOG
scores 0-5
activities of daily living (ADLs) in geriatric medicine
bathing
dressing
toileting
transferring
continence
eating
instrumental activities of daily living (IADLs) in geriatric medicine
use telephone
manage finances
shop
arrange transportation
housework
prepare meals
manage medications
functional status objective physical performance
gait speed
falls risk
falls risk
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
cormorbidity
increased polypharmacy
increased risk of drug adverse effects
falls risk
how is cognition relevant to RT
informed consent (capacity) - only the patient themself can give consent
compliance with procedural/treatment requirements
possibility of unknown cognitive issue
Assisted Decision Making (capacity) Act 2015
- 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”
what is dementia
- 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
symptoms of demetia
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
environmental design principles for people with dementia
- 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
what are BPSD
behaviours and psychological symptoms
behaviours:
- agitation
- aggression
- disinhibition
- shadowing
- sleep disturbance
- vocalisations
- wandering
psychological symptoms:
- delusions
- hallucinations
- irritability
- paranoia
- depression
- anxiety
- apathy
