In order to create a better treatment landscape for geriatric patients with cancer, patients need to be involved in the process in order to shape personalized interventions.
A population that is living longer means the number of geriatric patients with cancer is increasing, but an evidence gap exists in this population that researchers are slowly trying to fill, says Dr. Grant Williams.
Williams, a geriatrician oncologist and assistant professor at the University of Alabama, Birmingham, recently sat down with CURE® to discuss what the current treatment landscape in geriatric cancer looks like and where the field is going in the future.
The most important part, Williams says, is allowing patients to be a partner in their care by providing assessment tools that track their individual issues and concerns (such as malnutrition), then treating and creating interventions to manage those issues in order to ensure better outcomes.
CURE®: What does the current treatment landscape for geriatric cancer look like?
Williams: Well, it's getting better, mostly in the sense that there's a lot more people looking at this population. And I think it's unique that we have less data about older adults with cancer yet frankly, these are the majority of patients that we’re treating. So, I think there's a big evidence gap that I think we're slowly trying to fill and improve our understanding.
It's unique in this setting; some patients do well, just as well as younger patients, and some patients don't do as well. And you're at risk of over-treating and under-treating, so it's kind of walking a tightrope as far as choosing the appropriate treatments for this population.
I think we're getting better at developing tools so that people understand who may benefit and who's at risk with treatment. We're still working on trying to make those widely disseminated and widely used. We're using geriatric assessment here, particularly in some of our clinics in GI (gastrointestinal cancer) to kind of personalize these treatments based on patient factors. There's good evidence suggesting that that's important. It's included in the guidelines, whether it's ASCO (American Society of Clinical Oncology) or NCCN (National Comprehensive Cancer Network), but I think we also recognize that it isn't being widely used yet, and that there's still a lot of barriers to getting that to be part of routine care across the United States and across the globe.
So, it's getting better. And I will say part of it is the assessments of older adults, so we can personalize treatment. But there is another aspect, which is, how can we intervene and improve their outcomes? You know, and I think just recently, we started to see some, you know, studies presented at ASCO this year, in particular, where we're starting to see specific intervention studies in this population that that are suggesting that these personalized approaches really do help.
Where do you see the future of patient outcomes in this population heading?
Well, I think specifically, when we're talking about the older adult population, I think we're, we're finally getting more information about who is at risk and who may benefit from these cancer treatments, really refining that discussion that we're having with patients about the risk-benefit of treatment, because right now, it's kind of a little bit of a black box as far as understanding that.
Understanding that a patient that has malnutrition may really not do well with chemo because of toxicities. And using that same example, the next step is trying to move to intervention. So we don't want to just say sorry, you're at risk for severe toxicities. We want to say, look, you're at risk, but I think there are these things that we could do to try to mitigate or reduce that risk.
Actually, two studies just they haven't officially published, but were presented at ASCO, showed that they dropped the risk of severe toxicities by 10% by incorporating a geriatric assessment and doing interventions based on those measures.
So, I think with more evidence, we can kind of refine these treatment decisions. And then also, on top of that, adding interventions to improve outcomes in these patients that are at risk is my hope. And really, on top of all that, you know, understanding how this impacts function and cognition and all those other things that patients often ask.
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