Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers

TL;DR

This paper discusses how geriatric assessment and management can improve treatment outcomes and quality of life for older adults with non-colorectal digestive cancers.

Contribution

It highlights the under-recognized role of geriatricians in managing non-colorectal digestive cancers and provides a synthesis of current research on this topic.

Findings

Geriatric assessment can predict mortality and adverse events in older cancer patients.

Preoperative rehabilitation programs improve recovery and reduce hospital stays.

Geriatric co-management reduces chemotherapy side effects and improves quality of life.

Abstract

Digestive cancers are common among older adults, yet their management can be more challenging in this population given the physiological differences between older and younger patients. That is why geriatricians now work with cancer specialists to help in the decision process and identify patient frailties. Through a global assessment, including lifestyle, muscle function, nutrition, and psychological well-being, geriatricians can help build a tailored treatment. This may involve, depending on the chosen treatments, preparing patients for the surgery and improving their postoperative recovery, or mitigating the side effects of chemotherapy and other therapies. However, geriatrician contributions in the management of non-colorectal cancers (oesophagus, stomach, liver, pancreas, or biliary tract cancers) is not as well-known as in colon or rectal cancer. This paper aims to summarize current research on the geriatric management of non-colorectal digestive cancers: how it can be done and how it can improve treatment outcomes and patients’ quality of life.

Background: The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential. Methods: This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment. Results: Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3–5 adverse effects of chemotherapy in particular and improve quality of life. Conclusions: Co-management between geriatricians and other specialties should be encouraged wherever possible.

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