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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 795-796

Geriatric assessment to improve overall geriatric oncology outcomes: The need of the hour in resource-limited settings


1 Department of Medical Oncology, Cancer Institute (WIA), Apollo Proton Cancer Centre, Apollo Hospitals, Chennai, Tamil Nadu, India
2 Department of Radiation Oncology, Cancer Institute (WIA), Apollo Proton Cancer Centre, Apollo Hospitals, Chennai, Tamil Nadu, India

Date of Submission09-Nov-2021
Date of Decision16-Nov-2021
Date of Acceptance30-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Nikita Mehra
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_273_21

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How to cite this article:
Mehra N, Chilukuri S. Geriatric assessment to improve overall geriatric oncology outcomes: The need of the hour in resource-limited settings. Cancer Res Stat Treat 2021;4:795-6

How to cite this URL:
Mehra N, Chilukuri S. Geriatric assessment to improve overall geriatric oncology outcomes: The need of the hour in resource-limited settings. Cancer Res Stat Treat [serial online] 2021 [cited 2022 Aug 20];4:795-6. Available from: https://www.crstonline.com/text.asp?2021/4/4/795/334213



We read the article titled, “Oncologists' perceptions of the need for assessing individual domains in the geriatric assessment and worthwhile outcomes in treating older patients with cancer: A questionnaire-based survey” by Noronha et al.[1] published in the last issue of Cancer Research, Statistics, and Treatment. We wish to congratulate the authors for this successful original article and would like to make some contributions.

This original article, based on an online questionnaire survey obtained from oncologists, primarily medical oncologists working in academic medical centers in India, captures the healthcare professionals' perceptions of the requirement and value of objective geriatric assessments in the planning of treatment for geriatric patients with malignancies. The striking paradox in the survey results demonstrates the clear recognition for an objective and comprehensive geriatric assessment, in contrast to low referrals for specialized care, primarily attributed to logistical constraints such as human resources and time. Thus, the questionnaire-based survey provides a suitable framework to develop improved geriatric oncology care in our country and regions with a similar socioeconomic status. We would also argue that geriatric assessment-driven interventions, such as better symptom management, enhanced medical and psychological support, and treatment de-intensification/avoidance, are probably more relevant in low-resource settings; surveys such as this can direct the attention of the oncology community toward this key gap area.

We agree with the authors that the lack of knowledge/training is one of the most critical barriers to adopting geriatric assessment.[2] Given that the oncology trainees from all specialties have minimal exposure and time dedicated to geriatric oncology training, there is a significant gap in understanding the importance and impact of such instruments. Fortunately, the American Society of Clinical Oncology and other organizations have taken the initiative by including geriatric oncology in their core curriculum for hematology/oncology trainees.[3] Similar initiatives in India are the need of the hour to ensure that geriatric oncology gets the attention it deserves.[4]

The authors have diligently listed out the various domains in older patients with cancer that can influence outcomes. We would like to add that in lower socioeconomic countries, financial support is an essential determinant of outcomes.[5],[6]

It is also interesting to note that to the question, “What improvement in the outcomes would make geriatric assessments worthwhile?” two-thirds of the respondents chose reduction in toxicities, 90% chose improvement in quality of life, and 42% chose improvement in overall survival (alone or in combination with other outcomes). However, in a recently published randomized trial, the geriatric assessment-driven intervention significantly reduced chemotherapy-related grade 3 toxicities without improving the overall survival.[7] Although the respondents' preference for quality of life (patient-reported) over physician-reported toxicities as an endpoint is understandable, capturing the same in a clinical trial can be cumbersome and challenging.

In resource-limited settings, as highlighted in this survey, it is crucial to define the population that is likely to benefit from these assessments. Relatively straightforward age/comorbidity cut-offs may not be appropriate in a heterogeneous population. In this context, patient self-reported questionnaires would help in selecting candidates for more comprehensive multi-domain assessments. It is important to note that many of them remain more easily adaptable in high-resource settings.[8],[9] Both the self-reporting questionnaires and comprehensive assessments must be region-specific and assess unique local imbalances, including resource limitations.[10] Furthermore, even though comprehensive multidomain geriatric assessments have been tested and recommended, there is a need for relatively simplistic and practical instruments to enable the integration of geriatric assessments into routine clinical pathways.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Noronha V, Kalra D, Ramaswamy A, Gattani SC, Menon N, Patil VM, et al. Oncologists' perceptions of the need for assessing individual domains in the geriatric assessment and worthwhile outcomes in treating older patients with cancer: A questionnaire-based survey. Cancer Res Stat Treat 2021;4:492-8.  Back to cited text no. 1
  [Full text]  
2.
Noronha V, Talreja V, Joshi A, Patil V, Prabhash K. Survey for geriatric assessment in practicing oncologists in India. Cancer Res Stat Treat 2019;2:232-6.  Back to cited text no. 2
  [Full text]  
3.
Eid A, Hughes C, Karuturi M, Reyes C, Yorio J, Holmes H. An interprofessionally developed geriatric oncology curriculum for hematology-oncology fellows. J Geriatr Oncol 2015;6:165-73.  Back to cited text no. 3
    
4.
Rajpurohit A. Geriatric oncology in India: An unmet need. Cancer Res Stat Treat 2020;3:150-1.  Back to cited text no. 4
  [Full text]  
5.
Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet 2011;377:505-15.  Back to cited text no. 5
    
6.
Gupta A, Gyawali B. Digging deeper into cancer-associated financial toxicity in low- and middle-income countries. Cancer Res Stat Treat 2021;4:172-3.  Back to cited text no. 6
  [Full text]  
7.
Li D, Sun CL, Kim H, Soto-Perez-de-Celis E, Chung V, Koczywas M, et al. Geriatric Assessment-Driven Intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: A randomized clinical trial. JAMA Oncol 2021;7:e214158.  Back to cited text no. 7
    
8.
Loh KP, Soto-Perez-de-Celis E, Hsu T, de Glas NA, Battisti NM, Baldini C, et al. What every oncologist should know about geriatric assessment for older patients with cancer: Young international society of geriatric oncology position paper. J Oncol Pract 2018;14:85-94.  Back to cited text no. 8
    
9.
Noronha V, Ramaswamy A, Banavali S, Gattani S, Prabhash K. Ethnocultural inequity in the geriatric assessment. Cancer Res Stat Treat 2020;3:808-13.  Back to cited text no. 9
  [Full text]  
10.
Mehrotra R, Nethan ST, Yadav K. Socio-cultural tailoring of the comprehensive geriatric assessment tool for low- and middle-income countries: The need of the hour. Cancer Res Stat Treat 2021;4:370-3.  Back to cited text no. 10
  [Full text]  



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