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Older adults with cancer and their caregivers — current landscape and future directions for clinical care

Abstract

Despite substantial improvements in the outcomes of patients with cancer over the past two decades, older adults (aged ≥65 years) with cancer are a rapidly increasing population and continue to have worse outcomes than their younger counterparts. Managing cancer in this population can be challenging because of competing health and ageing-related conditions that can influence treatment decision-making and affect outcomes. Geriatric screening tools and comprehensive geriatric assessment can help to identify patients who are most at risk of poor outcomes from cancer treatment and to better allocate treatment for these patients. The use of evidence-based management strategies to optimize geriatric conditions can improve communication and satisfaction between physicians, patients and caregivers as well as clinical outcomes in this population. Clinical trials are currently underway to further determine the effect of geriatric assessment combined with management interventions on cancer outcomes as well as the predictive value of geriatric assessment in the context of treatment with contemporary systemic therapies such as immunotherapies and targeted therapies. In this Review, we summarize the unique challenges of treating older adults with cancer and describe the current guidelines as well as investigational studies underway to improve the outcomes of these patients.

Key points

  • Cancer is a disease of ageing; older adults (aged ≥65 years) account for most new cancer diagnoses and the majority of cancer survivors.

  • In comparison with older adults without cancer, those with cancer have an increased prevalence of comorbidities and ageing-related conditions that substantially affect cancer diagnosis, treatment and outcomes.

  • A comprehensive geriatric assessment is a multidimensional, multidisciplinary approach used to evaluate health and functional status in older adults, identify patients at increased risk of poor outcomes from cancer treatment, and guide decision-making and management recommendations.

  • The management of geriatric conditions in older adults with cancer might improve their outcomes; to achieve such advances, further therapeutic trials utilizing geriatric assessment and novel trial designs incorporating outcomes important to this population are required.

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Fig. 1: Increasing number of older survivors of cancer.
Fig. 2: Distress in cancer caregivers.

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Acknowledgements

The work of K.P.L. is supported by the National Cancer Institute (NIH K99 CA237744) and a Wilmot Research Fellowship Award. The work of A.M. is supported by the National Institute of Ageing (NIA) grant K76 AG064394. The work of S.G.M. is supported in part by an NIH R01 CA177592 and an NIH K24 AG056589 award.

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Correspondence to Sindhuja Kadambi or Supriya Mohile.

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K.P.L. is a consultant for Pfizer and Seattle Genetics. R.D. is an advisory board member for Exelixis. The other authors declare no competing interests.

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Kadambi, S., Loh, K.P., Dunne, R. et al. Older adults with cancer and their caregivers — current landscape and future directions for clinical care. Nat Rev Clin Oncol 17, 742–755 (2020). https://doi.org/10.1038/s41571-020-0421-z

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