Age-related considerations when providing radiotherapy to older patients with cancer

Abstract

The number of older patients with cancer is rapidly increasing and they exhibit large variation in health status. With age, physiological and functional reserves gradually decline, and can lead to a state of increased vulnerability to stressors known as frailty. To identify frailty and individualize the management of older patients with cancer, a geriatric assessment (GA) is recommended. GA is a systematic evaluation of domains where older adults commonly have problems such as comorbidity, polypharmacy, nutritional status, physical function, functional status, and psychosocial function. The objectives of this thesis were to investigate how geriatric impairments as identified by GA influence survival, quality of life (QoL) and physical function, and to explore cognitive trajectories among older patients with cancer receiving radiotherapy (RT). A prospective observational study including 301 patients ≥65 years refereed to RT with curative or palliative intent was conducted. GA was performed before and repeatedly after RT, and patients answered questionnaires assessing QoL and functioning. Nutritional deficiencies and poor functional status were associated with reduced survival. Moreover, survival declined with increasing number of geriatric impairments. Patient’s QoL, physical- and cognitive function remained relatively stable during follow-up. However, with increasing number of impairments patients consistently reported poorer QoL and physical function. In conclusion, older patients tolerated radiotherapy well, but those with several accumulated geriatric impairments were at risk of poor outcomes. The gradual decline in survival, QoL and physical function with increasing number of impairments indicate that frailty represents a continuum of increased vulnerability. This is essential because interventions aiming to ameliorate impairments may prevent further decline, and have the potential to improve outcomes for older patients with cancer.