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The Best Way to Care for Older Adults with Cancer
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Jul 1, 2025
Learn about geriatric assessment, what it includes and how it affects cancer care for elderly in a positive way. Other Podcasts for Deep Dive into Geriatric Oncology https://youtube.com/playlist?list=PLYGS6iJ2qRQn9Daebd7tj_XGegwjHZfvz&si=Wj5WeJucPFUSrEeV ------ Follow or reach out: https://x.com/GeriOncologist?t=CUzyZGLoJi3HTr5eR851FQ&s=09 or https://www.linkedin.com/in/arminshahrokni?utm_source=share&utm_campaign=share_via&utm_content=profile&utm_medium=android_app
View Video Transcript
0:05
okay let's dive in today we're getting
0:07
into something that's well becoming
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increasingly critical as our population
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ages cancer care tailored specifically
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for older adults you have sight we've
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been digging into some material uh
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particularly excerpts focused on
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geriatric oncology vital signs for older
0:24
patients and it really challenges some
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conventional thinking it really does and
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the mission for this deep dive really is
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to unpack the specialized kind of
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holistic approach this research
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highlights right and understand why it's
0:37
so essential to look beyond just you
0:39
know the number the age when treating
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cancer in older individuals start
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getting to the core of it exactly it's
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about finding what makes care effective
0:48
and compassionate in this specific
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context and right away the thing that
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jumped out at me the most striking point
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the material makes is how unreliable
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chronological age just the number of
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years someone's lived is for predicting
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how well they'll handle cancer treatment
1:01
mhm that feels well a bit
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counterintuitive doesn't it given how we
1:06
usually think about age and health it
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absolutely is and it's crucial because
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you see such well immense variability
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among older adults think about it you
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could have a really vibrant independent
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85year-old who's still I don't know
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traveling right and then a 70-year-old
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who's already dealing with significant
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heart issues maybe mobility problems big
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difference huge so giving them the exact
1:32
same treatment approach based only on
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their birth certificate it just doesn't
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make sense that variation is really the
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key then it's not just the years it's
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the whole health picture um maybe the
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miles on the clock and the condition of
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the engine so to speak that's a good way
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to put it so the research pivots away
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from just chronological age to what's
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sometimes called physiologic age okay
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which focuses much more on a person's
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actual overall health their function
1:58
their resilience how they're really
2:00
doing and a much more accurate snapshot
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exactly and the cornerstone tool that
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comes up again and again in this
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research for getting that accurate
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picture for looking at the whole person
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is the comprehensive geriatric
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assessment the CGA the TGA okay and this
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isn't just your standard checkup it's
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really multi-dimensional let's unpack
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that the CGA because it sounds like it
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covers so much more ground than just a
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typical medical history what are the
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core areas it digs into according to
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this material well uh first off it
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starts with functional status okay so
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this is really about assessing someone's
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ability to manage daily life we're
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talking activities of daily living ADLs
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the basics yeah the absolute basics
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bathing dressing eating and then also
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instrumental activities of daily living
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the IADLs which are more complex right
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things like managing their own
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medications shopping using the phone
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handling finances and knowing that
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straight away tells you how much support
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someone might need at home right which
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seems incredibly relevant for managing
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treatment side effects precisely it's
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fundamental the next is coorbidity okay
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that just means identifying all those
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other health conditions someone might
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have alongside the cancer you know heart
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disease diabetes kidney issues lung
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problems usual suspects often often yeah
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but what's critical here isn't just
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listing them it's understanding their
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severity and crucially how they might
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interact with potential cancer
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treatments ah the interaction yes
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because sometimes a comorbidity that
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seems stable can actually get
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significantly worse with chemo or
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radiation okay so it's the interplay not
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just the presence that makes sense and
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then there's the often overlooked area I
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think of polyarm pharmacy oh this is a
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huge one right many older adults are on
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multiple medications for all this
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coorbidities it's massive and the
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research really stresses the
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pharmacist's vital role here absolutely
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vital how so well when you introduce new
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cancer drugs into the mix there's a
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critical sometimes really dangerous
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potential for interactions with the
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medications they're already taking right
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think about someone taking say a blood
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thinner a diabetes drug maybe a heart
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pill and then starting chemotherapy that
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needs incredibly careful review to avoid
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serious complications yeah you can see
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how things could go wrong quickly
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exactly so it's not just listing the
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meds it's analyzing the whole drug
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cocktail you know that makes so much
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sense a pharmacist isn't just dispensing
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pills in this scenario they're really
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part of the safety team what else does
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the CGA capture uh it also assesses
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nutrition looking for things like recent
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weight loss poor appetite any signs of
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malnutrition and why is that so key
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because good nutrition isn't just about
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feeling well it directly impacts the
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body's ability to heal to maintain
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muscle mass and fundamentally to
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tolerate aggressive therapies okay a
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dietician's input here can be absolutely
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gamechanging as you can imagine then it
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also covers cognition so memory ability
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to think clearly right understanding the
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treatment plan exactly it's fundamental
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for patients to understand their
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diagnosis the treatment plan consent
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forms even just managing complex
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medication schedules safely at home
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because if you can't remember when to
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take your anti-nausea meds or which pill
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is which the best treatment plan in the
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world isn't going to work properly
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precisely and then rounding it out the
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CGA also looks at psychological state
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screening for things like depression or
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anxiety which are actually very common
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and can significantly impact treatment
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adherence and just quality of life
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and finally social support so
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understanding who is at home who can
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help with rides meals or just being
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there for emotional support the research
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highlights a strong support system as a
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major asset so the CGA creates this
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incredibly rich detailed profile of the
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person behind the diagnosis it's not
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just the cancer patient it's the whole
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individual exactly but how does
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gathering all this information which
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might even be surprising sometimes how
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does it fundamentally change how doctor
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actually decides on a treatment plan uh
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well this is where the assessment really
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pays off the material points to three
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major impacts first it's a really
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powerful predictor of treatment toxicity
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toxicity so side effects yeah severe
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side effects the research indicates the
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CGA is actually better than those
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standard oncology performance scores or
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even just age at identifying who is
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truly vulnerable who's likely to have a
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really rough time with chemotherapy or
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other treatments it can flag someone who
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might be younger but frail or maybe
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older but surprisingly robust much more
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accurately than the traditional methods
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so it helps predict who might run into
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trouble before they start that sounds
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invaluable for preventing harm what's
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the second impact second it guides
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proactive interventions and this is a
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key insight I think proactive yeah
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identifying problems before treatment
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starts allows the team to step in and
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address them like what well if the CGA
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shows malnutrition you bring in the
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dietitian now before treatment starts if
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there's a high fall risk or significant
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weakness maybe you start physical
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therapy before chemo weakens them even
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further ah so it's like prehabilitation
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getting them stronger beforehand exactly
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that's the concept fixing
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vulnerabilities before they cause a
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crisis during therapy that seems like a
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massive shift moving from just reactive
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care to actually proactive preparation
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what's the third big change the CGA
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brings it fundamentally facilitates
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shared decision-m okay how so well with
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all that CGA data the team can have a
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much more realistic nuanced conversation
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with the patient and their family they
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can lay it out okay based on your
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overall health profile your functional
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status your support system here are the
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treatment options makes sense this
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really aggressive option offers the best
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chance for cure maybe but it also
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carries a higher risk of impacting your
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independence landing you in the hospital
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four or this gentler option might mean
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the cancer is controlled rather than
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cured but it's much less likely to cause
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severe side effects and will likely help
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you maintain your quality of life stay
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at home so it allows the goals of the
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treatment to be truly personalized
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tailored to what matters most to that
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specific individual whether that's
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living longer at all costs or
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maintaining independence or prioritizing
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comfort precisely it aligns the
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treatment with the patients values now
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this level of comprehensive care this
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CGA these
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interventions it really sounds like it
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takes a village you know not just a
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single oncologist making all the calls
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absolutely and the material strongly
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reinforces this it describes the ideal
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setup as a multid-disciplinary team an
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MDT an MDT yeah it's not just one doctor
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it's like a symphony of specialists all
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contributing their unique expertise so
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who are the key players in this symphony
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that the research mentions well
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obviously you have the core oncology
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team the oncologist the oncology nurse
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but crucially the model brings in a
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geriatrician someone who specializes in
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the complexities of older adult health
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okay that makes sense then there's often
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a specialized geriatric oncology nurse
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the pharmacist we talked about who's so
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critical for managing polyfarm pharmacy
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right a social worker to help navigate
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support systems resources financial
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concerns physical and occupational
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therapists focusing on function mobility
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safety and the dietitian for nutrition
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wow each member brings a specific lens a
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specific skill set to support the
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patient from really every possible angle
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it sounds like a truly holistic safety
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net wrapped around the patient and their
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family okay let's try and bring this
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home for you listening right now if you
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are a patient or maybe a caregiver a
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family member navigating cancer
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treatment for an older loved one what
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are some practical things you should be
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asking the care team based on all this
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research yeah asking empowering
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questions is really key the research
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suggests asking directly things like
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beyond their age how are you assessing
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their overall fitness for this treatment
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are you looking at their function their
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other health issues that question alone
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immediately signals that you understand
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age isn't the only factor right exactly
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this sets a different tone also ask have
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you fully considered all their other
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health conditions and the medications
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they're taking how might those interact
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with the cancer treatment good one and
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critically what are the actual goals of
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this treatment are we aiming for cure
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control or comfort and what are the
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realistic potential impacts on their
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quality of life and their independence
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getting clarity on the goals and
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trade-offs yes it helps ensure everyone
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is on the same page about what success
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actually looks like for this specific
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individual and finally it sounds like
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maybe just asking about the team itself
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is important absolutely don't hesitate
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to ask is there a specialist we could
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consult who has expertise in geriatrics
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or perhaps is there a dedicated oncology
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pharmacist or a social worker available
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on the team right advocating for this
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comprehensive holistic look is really
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powerful that's excellent practical
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advice now let's flip it what about
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health care professionals who might be
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listening maybe primary care doctors
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nurses general oncologists who don't
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necessarily specialize in geriatrics
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what's the most important takeaway from
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this material for them well I think the
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key message is to start incorporating
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geriatric principles into your practice
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you don't necessarily need a full formal
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MDT available immediately to start
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making a difference so small steps
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exactly the research highlights that
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even using brief validated screening
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tools things like the G8 or the VSS13
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can quickly identify older patients who
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might be vulnerable and need a closer
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look maybe your referral so there are
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quick checks that can flag potential
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issues absolutely and even simpler than
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that the act of just asking some key
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questions during a regular visit can be
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incredibly valuable asking about falls
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in the last 6 months asking about any
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unintended weight loss asking if they're
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having any new difficulty with daily
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tasks getting dressed managing their
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pills cooking meals those sick but
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revealing questions very revealing also
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collaborate with your pharmacists they
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are often underutilized resources for
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reviewing complex medication lists work
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with social workers to understand a
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patient's home support situation the
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main thing is to be proactive in
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assessing vulnerability rather than just
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reacting when a complication crops up
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during treatment it really feels like
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this research is pushing for a
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fundamental shift in perspective it's
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moving from just targeting the disease
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in an older person to truly caring for
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the whole complex individual who happens
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to have cancer that's it exactly
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focusing on their overall well-being
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their function their quality of life
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just as much as the tumor response
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itself that's the absolute core of it
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personalized team-based cancer care for
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older adults is all about understanding
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and supporting the whole person to
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achieve the best possible outcome for
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them whatever that outcome might be and
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ultimately as this material really
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strongly suggests it's about making sure
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that in our efforts to add years to life
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we are just as dedicated if not more so
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to adding life to those years precisely
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put couldn't agree more so this deep
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dive has really really underscored that
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treating cancer effectively in older
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adults demands a much more nuanced uh
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comprehensive approach one that moves
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far beyond just looking at their date of
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birth using tools like the CGA embracing
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that multiddisciplinary team model it
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seems clear it can dramatically improve
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treatment tolerance guide crucial
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interventions before problems start and
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align care with what truly matters most
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to the individual patient usually their
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quality of life and their independence
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yeah looking at the whole person isn't
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just you know a nice idea or a soft
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skill it's becoming a fundamental
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clinical necessity and it's backed by
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the evidence it leads to more effective
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safer and ultimately more compassionate
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care so here's something to maybe maul
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over if applying this kind of detailed
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whole person assessment leads to
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demonstrabably better more personalized
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care with improved quality of life for
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older adults facing cancer
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how might this same holistic perspective
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potentially change how we approach
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health decisions or manage chronic
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diseases for individuals facing any
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significant health challenge really
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regardless of their age what
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possibilities does that expanded view
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open up for you
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[Music]
#Aging & Geriatrics
#Cancer