Geriatric Oncology Breakthrough!

With the intensification of population aging, the incidence of tumors in the elderly population is also increasing year by year

"The Lancet" (The Lancet) recently published a study from the Wilmot Cancer Institute team at the University of Rochester Medical Center.

Specifically, in this study, the elderly (70 years and older) cancer patients safely reduced the dose of therapeutic drugs (such as chemotherapy drugs) and reduced serious toxicity by 20% without affecting their overall survival.

Paper noted that the study "the first time that a treatment strategy based on histological evaluation of the elderly in clinical practice can bring significant benefit to cancer patients in randomized controlled trials"

Screenshot source: The Lancet

The GAP70+ trial aims to identify the benefits of geriatric evaluation and corresponding management of the evaluation results in clinical practice for cancer patients in the American community

The inclusion criteria of patients are: age 70 years and above; according to the assessment criteria, they have one or more gerontological treatment risks (specific items include patients' physical activity, multiple medications, coexisting diseases, functional status, nutrition, cognition, social support, and psychological status ); Begin to receive palliative treatment with a higher risk of toxicity

The patients included in the trial were assigned to the intervention group and the routine care group at a ratio of 1:1

The results of the analysis showed that: 718 patients were recruited in this trial.

In the first three months of treatment, the incidence of grade 3-5 toxic side effects in the intervention group compared with those in the conventional care group was significantly reduced, from 71% (263/369) to 51% (177/349)

▲The incidence of grade 3-5 toxic side effects of patients in the intervention group (blue) and routine care group (grey) 3 months before treatment (picture source: reference [1])

The researchers explained that this was mainly related to the adjustment of the initial medication dosage.

It is worth noting that there was no significant difference in overall survival rates between the two study groups at 6 months and 12 months

▲The overall survival of the two groups of patients was similar after treatment for 1 year (picture source: reference [1])

In addition, compared with the conventional care group, elderly patients in the intervention group had a 42% lower risk of falls in the first 3 months of treatment (aRR=0.

The study authors emphasize that clinical oncologists usually treat patients in accordance with standard cancer treatment guidelines

The results of this study confirm that clinicians can have a more comprehensive understanding of patients through gerontological assessment, and observe the effects of therapeutic drugs on other clinical diseases (such as diabetes, etc.

A review article published in the same journal of The Lancet pointed out that 60% of cancers and 70% of cancer-related deaths occur in elderly patients, which shows the importance of conducting geriatric research in the field of oncology

In addition, elderly cancer patients, especially those with severe comorbidities or other senile disorders, are most likely to receive treatment in community primary medical centers

Reference

[1] Mohile, Supriya G.
, et al.
"Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study.
" The Lancet (2021).

[2] Hamaker, Marije E.
, and Siri Rostoft.
"Geriatric assessment in older patients with cancer: a new standard of care.
" Lancet (London, England) (2021).