The Journal of Clinical Oncology has recently published its second special edition devoted to Geriatric Oncology. The impetus for the issue was the recognition that the older cancer population is growing rapidly, reflecting the aging of the population. This was recognized by leaders in oncology in 1983 when a symposium was organized to address this issue.
At that time there were a number of issues raised which are still relevant. This includes the recognition of the difference between physiologic and calendar age and the need to examine the factors unique to older cancer patients. These leaders established a research agenda, including analyses of databases, development of prospective clinical trials, longitudinal studies, pharmacokinetics and drug sensitivity of elderly cancer patients, quality of life issues, and physical education. Dr. B.J. Kennedy, as president of the American Society of Clinical Oncology (ASCO) in 1988, and in subsequent writings, emphasized the need to study aging and cancer.
The August 20th special edition of the Journal of Clinical Oncology highlights a number of issues in the field. It brings the readers new information on evidence-based treatment recommendations and discusses areas where data is lacking to stimulate research in these areas. The issue is broadly divided into a number of topics including disease-specific reviews (breast, ovary, lung, colon, prostate, leukemia, and multiple myeloma), clinical trial design methodology, geriatric assessment of the older patient, and survivorship issues (J. Clin. Onc. August 2014 [doi10.1200/JCO.2014.57.4822]).
For the field to advance, physician education is the key factor. Oncologists need to realize that the older patients are now and will continue to be the largest segment of patients they treat. Due to multiple comorbidities, geriatric syndromes, frailty, dependence, and other factors, decision making, whether it is in surgery, radiation, or medical oncology, will be increasingly complex. Physicians need the tools to make these decisions. Studies of geriatric assessment have clearly shown that clinical judgment is not enough.
In addition, the needs, wishes, and goals of the patients and their caregivers need to be central to decision making. Fortunately, Geriatric Oncology has been making inroads into these areas through the work of many individuals and organizations. The International Society of Geriatric Oncology, founded in 2000, has a strong and formalized organizational structure. It has formed a number of task forces which have formulated position papers and treatment recommendations. Its annual meeting is a valuable resource for presentation of data, networking, and stimulation of research concepts. The official journal of the society, the Journal of Geriatric Oncology has been an important avenue for the dissemination of advances in the field.
The Cancer and Aging Research Group has taken a strong leadership role in the field and has been a valuable training ground for young investigators and already has made significant contributions to geriatric assessment and evaluation.
ASCO has long recognized the importance of this issue. The society established a Geriatric Oncology track at the annual meeting with a Clinical Science Symposium, an Educational Committee group, a Special Interest Group, sessions at the ASCO/AACR Vail Clinical Trials Work on Special Populations, a Guidelines group, and the annual B.J. Kennedy Award for Scientific Excellence in Geriatric Oncology.
The Alliance for Clinical Trials in Oncology (formerly CALGB) has had a Cancer in the Elderly Committee since 1995 and has made a major impact. It is currently doing a series of important database analyses. The Elderly Taskforce of the Gynecologic Oncology Group is conducting a prospective trial in older women with ovarian cancer, evaluating efficacy and the predictive value of a cancer-specific geriatric assessment.
Physicians caring for older cancer patients need to understand basic geriatric principles to be able to adequately assess their patients. The geriatric oncology researchers need to provide easily administered, validated, predictive models to help the practitioners. Patients need to be encouraged to participate in clinical trials, even those not elderly specific, so data can be obtained to help in future decision making. The older cancer patients need to be focus of endeavors. They deserve nothing less.
Dr. Stuart M. Lichtman is professor of medicine, Weill Cornell Medical College, New York, and recipient of the 2014 ASCO B.J. Kennedy Award for Scientific Excellence in Geriatric Oncology.