Treating GI tumours in geriatric patients

Gastrointestinal tumours occur most frequently in people over 70. But how does the treatment of geriatric patients differ from that of younger patients?

Cancer care for older patients is not optimal

"Cancer care for geriatric patients is suboptimal," said Dr Isacco Montroni at the ESMO GI Congress 2024. People of advanced age with cancer have poorer survival rates than younger cancer patients, not because of comorbidities or advanced age, but because their cancer is treated incorrectly. After 70, major surgery for colorectal cancer is no longer recommended, and people over 80 generally receive major surgery in less than 30% of cases. Furthermore, it is difficult to extrapolate clinical trial results to affected older patients, as the participants in such trials are mostly younger.

Decisive criterion: frailty

However, it is precisely the dogma of not performing surgery after a certain age that results in the increased death rates of older patients with GI tumours. This is because no distinction is often made between chronological and biological age, says Montroni. However, a detailed medical history in advance is essential, in particular an assessment of the frailty of the geriatric patient. Several criteria - physical, psychological, social - are used to predict how well a patient would cope with an operation.

After all, if geriatric patients are still fit, they often have a life expectancy of another 10 years - so why not operate if the frailty index favours it?

Prehabilitation before GI tumour surgery is essential

If an operation is planned after sufficient consideration, the keyword is prehabilitation. Even if there are fit geriatric patients, they will not heal as quickly after surgery as a mid-20-year-old. It is therefore essential to prepare well for the operation. Be it with a change in diet, discussions with psychological experts or increasing physical activity. The increase in minimally invasive procedures in the area of gastrointestinal tumours is a further argument in favour of increasing the number of operations performed on older patients, as smaller operations mean less stress for the body.

But what outcome do patients actually want? Patients' wishes and expectations also make it easier to decide on treatment. Functional recovery is particularly important to patients, i.e. being able to go about their daily lives as they did before the diagnosis.

An individual risk assessment and frailty assessment must therefore be carried out, as this is the only way to ensure optimal results in the treatment of gastrointestinal tumours in older patients.

Source
  1. Session: GI cancer management in elderly patients. ESMO GI Congress 2024, 29.06., 8:30h / Isacco Montroni, Mark A. Baxter, Stephen Fenwick, Efrat Dotan.