The application of the principles of geriatrics to the management of the older person with cancer

Is the patient going to die of cancer or with cancer? Is the patient going to suffer pain and disability due to cancer? Is the patient able to tolerat e aggressive life-prolonging treatment? This paper tries to reply to the fu ndamentals of these questions by introducing the multidimensional assessmen t that evaluates areas where age-related changes are more likely. Chronolog ic age cannot be used to predict the degree of comorbidity and of functiona l deterioration of the single individual up to age 85 at least. Assessment of aging includes health, functional status, nutrition, cognition, socio-ec onomic and emotion evaluations. This multidisciplinary assessment is referr ed to as comprehensive geriatric assessment (CGA). The risk of comorbid con ditions increases with age and may result in underdiagnosis: in older patie nts, new symptoms may not be clearly recognized by the patient and may be d ismissed by practitioners as manifestations of preexisting conditions. A me aningful assessment of comorbidity may be obtained with a comorbidity index . The Charlson scale and the Chronic Illness Rating Scale - Geriatric (CIRS -G), have enjoyed the widest acceptance, The Instrumental Activities of Dai ly Living (IADL) and the Activities of Daily Living (ADL) are the most sens itive assessment of function in older individuals, IADLs include shopping, managing finances, housekeeping, laundry, meal preparation, ability to use transportation and telephone and ability to take medications: in simple wor ds, the IADLs are those skills a person needs to live independently. ADLs i nclude feeding, grooming, transferring, toiletting and are the skills neces sary for basic living. Though a correlation exists among comorbidity, perfo rmance status, ADL and IADL, this correlation is not strong enough to be re flected in a single parameter. The Folstein Mini Mental Status (MMS), is th e instrument of most frequent use to screen older individuals for dementia. The main problem with the MMS is lack of sensitivity to early stages of de mentia. The Geriatric Depression Scale (GDS), a simple tool that can be com pleted by most patients at home, doubles the rate of detection of depressio n. The Mini Nutritional assessment is very sensitive to screen older person s for malnutrition. The risk of polypharmacy increases with age and partly results from the fact that older patients visit different practitioners. PI CGA should also include evaluation of the so called Geriatric Syndromes li ke delirium, incontinence, osteoporosis, all of which represent a hallmark of frailty. The CGA may help the management of older individuals with cance r in at least three areas. detection of frailty, treatment of unsuspected c onditions, removal of social barrier to treatment. (C) 2000 Published by El sevier Science Ireland Ltd.