Geriatric assessment guides treatment strategy for older adults with cancer
December 1, 2017 | by City of Hope
Though it is widely acknowledged that cancer is a disease of aging, older adults remain under-represented on clinical trials which inform the standard of care. Hence there is less evidence on how to best care for this often vulnerable population. Moreover, though clinicians often rely on a patient's chronological age to inform the treatment course and predict the patient's tolerance to chemotherapy, chronological age alone does not adequately capture the complexities of an older adult's health status.
In response to these challenges, Arti Hurria, M.D., The George Tsai Family Chair in Geriatric Oncology, and colleagues created the comprehensive geriatric assessment tool that incorporates questions of functional status, medications, comorbidities, nutritional status, and cognitive and psychosocial function to use in a routine clinical setting, as well as oncology research trials.
The tool is primarily self-administered by the patients and includes three items that are completed by a health care professional. While assessing take some time to complete, it offers a wide range of benefits to physicians and patients alike. These include the identification of polypharmacy, multimorbidity, social isolation and nutritional, social or cognitive issues, all of which have bearing on a patient's survival and potential for experiencing treatment-related side effects.
Identifying aging-related biomarkers to predict treatment outcomes
One of the most intriguing and increasingly pertinent challenges in geriatric cancer survivorship is the recent accumulation of evidence supporting the hypothesis that cancer and cancer treatment may accelerate the aging process.
The comprehensive geriatric assessment tool is the first step to being able to discern with accuracy and speed a patient's risk of chemotherapy toxicity. To that end, Hurria and co-investigator David Duggan, Ph.D., of the Translational Genomics Research Institute, are now beginning to explore how genetic and epigenetic markers may be associated with accelerated aging. This research is part of a genome-wide association study and is supported by a grant from the Breast Cancer Research Foundation
The investigators are focusing their research on specific biomarkers of aging, including markers of inflammation and coagulations and the P16ink4a gene. The questions Hurria and Duggan are asking are: How are these biomarker levels associated with the risk of chemotherapy toxicity and what longitudinal changes in biomarkers of aging occur during the aging process?This research could help elucidate the underlying biology behind accelerated aging in patients with cancer, as well as identify possible methods of intervention to minimize the effects of biological aging.
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Renowned Cancer Researcher Named President of City of Hope National Medical Center and Physician-in-Chief of City of Hope