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Learn about geriatric assessment, what it includes and how it affects cancer care for elderly in a positive way.
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0:05
okay let's dive in today we're getting
0:07
into something that's well becoming
0:09
increasingly critical as our population
0:11
ages cancer care tailored specifically
0:14
for older adults you have sight we've
0:17
been digging into some material uh
0:19
particularly excerpts focused on
0:21
geriatric oncology vital signs for older
0:24
patients and it really challenges some
0:26
conventional thinking it really does and
0:28
the mission for this deep dive really is
0:30
to unpack the specialized kind of
0:33
holistic approach this research
0:34
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
0:42
cancer in older individuals start
0:44
getting to the core of it exactly it's
0:46
about finding what makes care effective
0:48
and compassionate in this specific
0:50
context and right away the thing that
0:52
jumped out at me the most striking point
0:53
the material makes is how unreliable
0:56
chronological age just the number of
0:57
years someone's lived is for predicting
0:59
how well they'll handle cancer treatment
1:01
mhm that feels well a bit
1:03
counterintuitive doesn't it given how we
1:06
usually think about age and health it
1:08
absolutely is and it's crucial because
1:10
you see such well immense variability
1:14
among older adults think about it you
1:17
could have a really vibrant independent
1:19
85year-old who's still I don't know
1:22
traveling right and then a 70-year-old
1:24
who's already dealing with significant
1:26
heart issues maybe mobility problems big
1:29
difference huge so giving them the exact
1:32
same treatment approach based only on
1:34
their birth certificate it just doesn't
1:36
make sense that variation is really the
1:38
key then it's not just the years it's
1:40
the whole health picture um maybe the
1:43
miles on the clock and the condition of
1:46
the engine so to speak that's a good way
1:48
to put it so the research pivots away
1:50
from just chronological age to what's
1:52
sometimes called physiologic age okay
1:54
which focuses much more on a person's
1:56
actual overall health their function
1:58
their resilience how they're really
2:00
doing and a much more accurate snapshot
2:02
exactly and the cornerstone tool that
2:03
comes up again and again in this
2:05
research for getting that accurate
2:06
picture for looking at the whole person
2:08
is the comprehensive geriatric
2:09
assessment the CGA the TGA okay and this
2:13
isn't just your standard checkup it's
2:15
really multi-dimensional let's unpack
2:17
that the CGA because it sounds like it
2:19
covers so much more ground than just a
2:21
typical medical history what are the
2:23
core areas it digs into according to
2:26
this material well uh first off it
2:28
starts with functional status okay so
2:30
this is really about assessing someone's
2:32
ability to manage daily life we're
2:34
talking activities of daily living ADLs
2:37
the basics yeah the absolute basics
2:39
bathing dressing eating and then also
2:43
instrumental activities of daily living
2:46
the IADLs which are more complex right
2:48
things like managing their own
2:50
medications shopping using the phone
2:52
handling finances and knowing that
2:53
straight away tells you how much support
2:55
someone might need at home right which
2:57
seems incredibly relevant for managing
3:00
treatment side effects precisely it's
3:02
fundamental the next is coorbidity okay
3:04
that just means identifying all those
3:06
other health conditions someone might
3:07
have alongside the cancer you know heart
3:10
disease diabetes kidney issues lung
3:13
problems usual suspects often often yeah
3:17
but what's critical here isn't just
3:19
listing them it's understanding their
3:21
severity and crucially how they might
3:24
interact with potential cancer
3:26
treatments ah the interaction yes
3:29
because sometimes a comorbidity that
3:32
seems stable can actually get
3:34
significantly worse with chemo or
3:37
radiation okay so it's the interplay not
3:39
just the presence that makes sense and
3:41
then there's the often overlooked area I
3:43
think of polyarm pharmacy oh this is a
3:44
huge one right many older adults are on
3:46
multiple medications for all this
3:48
coorbidities it's massive and the
3:51
research really stresses the
3:52
pharmacist's vital role here absolutely
3:54
vital how so well when you introduce new
3:57
cancer drugs into the mix there's a
3:59
critical sometimes really dangerous
4:01
potential for interactions with the
4:02
medications they're already taking right
4:04
think about someone taking say a blood
4:06
thinner a diabetes drug maybe a heart
4:08
pill and then starting chemotherapy that
4:11
needs incredibly careful review to avoid
4:14
serious complications yeah you can see
4:16
how things could go wrong quickly
4:18
exactly so it's not just listing the
4:20
meds it's analyzing the whole drug
4:21
cocktail you know that makes so much
4:23
sense a pharmacist isn't just dispensing
4:26
pills in this scenario they're really
4:28
part of the safety team what else does
4:30
the CGA capture uh it also assesses
4:33
nutrition looking for things like recent
4:35
weight loss poor appetite any signs of
4:38
malnutrition and why is that so key
4:41
because good nutrition isn't just about
4:42
feeling well it directly impacts the
4:45
body's ability to heal to maintain
4:47
muscle mass and fundamentally to
4:50
tolerate aggressive therapies okay a
4:52
dietician's input here can be absolutely
4:55
gamechanging as you can imagine then it
4:56
also covers cognition so memory ability
4:59
to think clearly right understanding the
5:01
treatment plan exactly it's fundamental
5:03
for patients to understand their
5:04
diagnosis the treatment plan consent
5:07
forms even just managing complex
5:09
medication schedules safely at home
5:11
because if you can't remember when to
5:12
take your anti-nausea meds or which pill
5:15
is which the best treatment plan in the
5:16
world isn't going to work properly
5:18
precisely and then rounding it out the
5:20
CGA also looks at psychological state
5:22
screening for things like depression or
5:24
anxiety which are actually very common
5:26
and can significantly impact treatment
5:28
adherence and just quality of life
5:32
and finally social support so
5:34
understanding who is at home who can
5:36
help with rides meals or just being
5:38
there for emotional support the research
5:41
highlights a strong support system as a
5:43
major asset so the CGA creates this
5:47
incredibly rich detailed profile of the
5:49
person behind the diagnosis it's not
5:52
just the cancer patient it's the whole
5:53
individual exactly but how does
5:55
gathering all this information which
5:56
might even be surprising sometimes how
5:59
does it fundamentally change how doctor
6:01
actually decides on a treatment plan uh
6:03
well this is where the assessment really
6:05
pays off the material points to three
6:08
major impacts first it's a really
6:10
powerful predictor of treatment toxicity
6:13
toxicity so side effects yeah severe
6:15
side effects the research indicates the
6:17
CGA is actually better than those
6:19
standard oncology performance scores or
6:21
even just age at identifying who is
6:23
truly vulnerable who's likely to have a
6:25
really rough time with chemotherapy or
6:27
other treatments it can flag someone who
6:29
might be younger but frail or maybe
6:32
older but surprisingly robust much more
6:35
accurately than the traditional methods
6:37
so it helps predict who might run into
6:39
trouble before they start that sounds
6:42
invaluable for preventing harm what's
6:44
the second impact second it guides
6:46
proactive interventions and this is a
6:48
key insight I think proactive yeah
6:51
identifying problems before treatment
6:53
starts allows the team to step in and
6:55
address them like what well if the CGA
6:58
shows malnutrition you bring in the
7:00
dietitian now before treatment starts if
7:02
there's a high fall risk or significant
7:04
weakness maybe you start physical
7:06
therapy before chemo weakens them even
7:08
further ah so it's like prehabilitation
7:10
getting them stronger beforehand exactly
7:12
that's the concept fixing
7:14
vulnerabilities before they cause a
7:15
crisis during therapy that seems like a
7:17
massive shift moving from just reactive
7:20
care to actually proactive preparation
7:22
what's the third big change the CGA
7:24
brings it fundamentally facilitates
7:26
shared decision-m okay how so well with
7:29
all that CGA data the team can have a
7:31
much more realistic nuanced conversation
7:34
with the patient and their family they
7:36
can lay it out okay based on your
7:38
overall health profile your functional
7:41
status your support system here are the
7:44
treatment options makes sense this
7:45
really aggressive option offers the best
7:48
chance for cure maybe but it also
7:50
carries a higher risk of impacting your
7:52
independence landing you in the hospital
7:54
four or this gentler option might mean
7:57
the cancer is controlled rather than
7:58
cured but it's much less likely to cause
8:01
severe side effects and will likely help
8:03
you maintain your quality of life stay
8:05
at home so it allows the goals of the
8:07
treatment to be truly personalized
8:09
tailored to what matters most to that
8:11
specific individual whether that's
8:12
living longer at all costs or
8:14
maintaining independence or prioritizing
8:16
comfort precisely it aligns the
8:18
treatment with the patients values now
8:20
this level of comprehensive care this
8:22
CGA these
8:24
interventions it really sounds like it
8:26
takes a village you know not just a
8:28
single oncologist making all the calls
8:30
absolutely and the material strongly
8:33
reinforces this it describes the ideal
8:36
setup as a multid-disciplinary team an
8:38
MDT an MDT yeah it's not just one doctor
8:42
it's like a symphony of specialists all
8:44
contributing their unique expertise so
8:46
who are the key players in this symphony
8:48
that the research mentions well
8:50
obviously you have the core oncology
8:51
team the oncologist the oncology nurse
8:54
but crucially the model brings in a
8:57
geriatrician someone who specializes in
8:59
the complexities of older adult health
9:01
okay that makes sense then there's often
9:02
a specialized geriatric oncology nurse
9:04
the pharmacist we talked about who's so
9:07
critical for managing polyfarm pharmacy
9:09
right a social worker to help navigate
9:11
support systems resources financial
9:13
concerns physical and occupational
9:15
therapists focusing on function mobility
9:18
safety and the dietitian for nutrition
9:21
wow each member brings a specific lens a
9:24
specific skill set to support the
9:26
patient from really every possible angle
9:29
it sounds like a truly holistic safety
9:30
net wrapped around the patient and their
9:32
family okay let's try and bring this
9:34
home for you listening right now if you
9:35
are a patient or maybe a caregiver a
9:37
family member navigating cancer
9:39
treatment for an older loved one what
9:41
are some practical things you should be
9:42
asking the care team based on all this
9:44
research yeah asking empowering
9:47
questions is really key the research
9:49
suggests asking directly things like
9:52
beyond their age how are you assessing
9:54
their overall fitness for this treatment
9:56
are you looking at their function their
9:58
other health issues that question alone
9:59
immediately signals that you understand
10:01
age isn't the only factor right exactly
10:04
this sets a different tone also ask have
10:08
you fully considered all their other
10:09
health conditions and the medications
10:11
they're taking how might those interact
10:13
with the cancer treatment good one and
10:15
critically what are the actual goals of
10:17
this treatment are we aiming for cure
10:19
control or comfort and what are the
10:21
realistic potential impacts on their
10:23
quality of life and their independence
10:25
getting clarity on the goals and
10:27
trade-offs yes it helps ensure everyone
10:30
is on the same page about what success
10:32
actually looks like for this specific
10:34
individual and finally it sounds like
10:36
maybe just asking about the team itself
10:37
is important absolutely don't hesitate
10:40
to ask is there a specialist we could
10:42
consult who has expertise in geriatrics
10:45
or perhaps is there a dedicated oncology
10:47
pharmacist or a social worker available
10:49
on the team right advocating for this
10:52
comprehensive holistic look is really
10:54
powerful that's excellent practical
10:57
advice now let's flip it what about
11:00
health care professionals who might be
11:01
listening maybe primary care doctors
11:04
nurses general oncologists who don't
11:06
necessarily specialize in geriatrics
11:08
what's the most important takeaway from
11:10
this material for them well I think the
11:12
key message is to start incorporating
11:14
geriatric principles into your practice
11:16
you don't necessarily need a full formal
11:19
MDT available immediately to start
11:21
making a difference so small steps
11:24
exactly the research highlights that
11:25
even using brief validated screening
11:27
tools things like the G8 or the VSS13
11:30
can quickly identify older patients who
11:32
might be vulnerable and need a closer
11:34
look maybe your referral so there are
11:36
quick checks that can flag potential
11:38
issues absolutely and even simpler than
11:40
that the act of just asking some key
11:42
questions during a regular visit can be
11:44
incredibly valuable asking about falls
11:46
in the last 6 months asking about any
11:49
unintended weight loss asking if they're
11:51
having any new difficulty with daily
11:53
tasks getting dressed managing their
11:55
pills cooking meals those sick but
11:57
revealing questions very revealing also
12:01
collaborate with your pharmacists they
12:02
are often underutilized resources for
12:04
reviewing complex medication lists work
12:07
with social workers to understand a
12:08
patient's home support situation the
12:11
main thing is to be proactive in
12:13
assessing vulnerability rather than just
12:15
reacting when a complication crops up
12:18
during treatment it really feels like
12:20
this research is pushing for a
12:21
fundamental shift in perspective it's
12:23
moving from just targeting the disease
12:25
in an older person to truly caring for
12:28
the whole complex individual who happens
12:30
to have cancer that's it exactly
12:32
focusing on their overall well-being
12:33
their function their quality of life
12:35
just as much as the tumor response
12:36
itself that's the absolute core of it
12:39
personalized team-based cancer care for
12:41
older adults is all about understanding
12:43
and supporting the whole person to
12:45
achieve the best possible outcome for
12:47
them whatever that outcome might be and
12:49
ultimately as this material really
12:51
strongly suggests it's about making sure
12:52
that in our efforts to add years to life
12:55
we are just as dedicated if not more so
12:58
to adding life to those years precisely
13:00
put couldn't agree more so this deep
13:03
dive has really really underscored that
13:05
treating cancer effectively in older
13:07
adults demands a much more nuanced uh
13:11
comprehensive approach one that moves
13:13
far beyond just looking at their date of
13:15
birth using tools like the CGA embracing
13:18
that multiddisciplinary team model it
13:21
seems clear it can dramatically improve
13:22
treatment tolerance guide crucial
13:24
interventions before problems start and
13:26
align care with what truly matters most
13:28
to the individual patient usually their
13:30
quality of life and their independence
13:32
yeah looking at the whole person isn't
13:34
just you know a nice idea or a soft
13:36
skill it's becoming a fundamental
13:38
clinical necessity and it's backed by
13:40
the evidence it leads to more effective
13:42
safer and ultimately more compassionate
13:45
care so here's something to maybe maul
13:47
over if applying this kind of detailed
13:50
whole person assessment leads to
13:52
demonstrabably better more personalized
13:54
care with improved quality of life for
13:56
older adults facing cancer
13:58
how might this same holistic perspective
14:01
potentially change how we approach
14:02
health decisions or manage chronic
14:04
diseases for individuals facing any
14:06
significant health challenge really
14:07
regardless of their age what
14:09
possibilities does that expanded view
14:11
open up for you
14:12
[Music]
#Aging & Geriatrics
#Cancer