Indeed, pretreatment brief geriatric assessments are now being incorporated into many ongoing oncology clinical trials applying a new and badly needed focus on elderly patients with a variety of cancers, he added.
Geriatric assessments done in real time in the office "might help you identify certain problems in your patients and intervene before you get them on adjuvant chemotherapy or radiation therapy," Dr. Muss explained.
For example, identifying an elderly patient who is predisposed to falling might generate a referral to physical therapy for balance training prior to adjuvant therapy. That could improve quality of life and functional status and might even extend survival. This prospect is going to be tested in a planned randomized trial with standard care in the control group.
Also under active study are a variety of biomarkers that might predict chemotherapy toxicity and functional loss. Dr. Muss and coworkers are focusing on p16INK4A, also known as cyclin-dependent kinase inhibitor 2A or multiple tumor suppressor 1. Levels of this protein increase dramatically with tissue aging.
"As cells accumulate this protein due to increased gene expression, they become senescent. (That finding applies to) all our cells, from our blood cells to our T cells to our glomerular cells. So this is a wonderful marker of aging and we want to see if it’s an independent predictor of toxicity and functional loss. We’re doing those studies now," he said.
Dr. Muss reported that he serves as a consultant to Pfizer and Eisai.