NCCN Guidelines® Insights: Older Adult Oncology, Version 1.2021

Featured Updates to the NCCN Guidelines

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  • 1 Fox Chase Cancer Center;
  • | 2 UCSF Helen Diller Family Comprehensive Cancer Center;
  • | 3 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;
  • | 4 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;
  • | 5 Duke Cancer Institute;
  • | 6 Moffitt Cancer Center;
  • | 7 Yale Cancer Center/Smilow Cancer Hospital;
  • | 8 Huntsman Cancer Institute at the University of Utah;
  • | 9 Abramson Cancer Center at the University of Pennsylvania;
  • | 10 Mayo Clinic Cancer Center;
  • | 11 University of Michigan Rogel Cancer Center;
  • | 12 Dana-Farber/Brigham and Women’s Cancer Center;
  • | 13 University of Colorado Cancer Center;
  • | 14 Fred & Pamela Buffett Cancer Center;
  • | 15 Memorial Sloan Kettering Cancer Center;
  • | 16 Robert H. Lurie Comprehensive Cancer Center of Northwestern University;
  • | 17 Vanderbilt-Ingram Cancer Center;
  • | 18 UT Southwestern Simmons Comprehensive Cancer Center;
  • | 19 Roswell Park Comprehensive Cancer Center;
  • | 20 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;
  • | 21 The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;
  • | 22 UCLA Jonsson Comprehensive Cancer Center;
  • | 23 City of Hope National Medical Center;
  • | 24 UC San Diego Moores Cancer Center;
  • | 25 University of Wisconsin Carbone Cancer Center;
  • | 26 Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;
  • | 27 The University of Texas MD Anderson Cancer Center;
  • | 28 O'Neal Comprehensive Cancer Center at UAB; and
  • | 29 National Comprehensive Cancer Network.

The NCCN Guidelines for Older Adult Oncology address specific issues related to the management of cancer in older adults, including screening and comprehensive geriatric assessment (CGA), assessing the risks and benefits of treatment, preventing or decreasing complications from therapy, and managing patients deemed to be at high risk for treatment-related toxicity. CGA is a multidisciplinary, in-depth evaluation that assesses the objective health of the older adult while evaluating multiple domains, which may affect cancer prognosis and treatment choices. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines providing specific practical framework for the use of CGA when evaluating older adults with cancer.

  • 1.

    Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin 2021;71:733.

  • 2.

    Noone AM, Krapcho M, Miller D, et al., eds. SEER cancer statistics review, 1975-2015, National Cancer Institute. Bethesda, MD. Available at: https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018. Accessed August 2, 2021.

    • Search Google Scholar
    • Export Citation
  • 3.

    Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009;27:27582765.

  • 4.

    Balducci L. Management of cancer in the elderly. Oncology (Williston Park) 2006;20:135143; discussion 144, 146, 151–132.

  • 5.

    Saltzstein SL, Behling CA. 5- and 10-year survival in cancer patients aged 90 and older: a study of 37,318 patients from SEER. J Surg Oncol 2002;81:113116; discussion 117.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Extermann M. Management issues for elderly patients with breast cancer. Curr Treat Options Oncol 2004;5:161169.

  • 7.

    Decoster L, Van Puyvelde K, Mohile S, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol 2015;26:288300.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Soubeyran P, Bellera C, Goyard J, et al. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study. PLoS One 2014;9:e115060.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Pal SK, Katheria V, Hurria A. Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. CA Cancer J Clin 2010;60:120132.

  • 10.

    Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014;32:25952603.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Mohile SG, Velarde C, Hurria A, et al. Geriatric assessment-guided care processes for older adults: a Delphi consensus of geriatric oncology experts. J Natl Compr Canc Netw 2015;13:11201130.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011;29:34573465.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Hurria A, Mohile S, Gajra A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol 2016;34:23662371.

  • 14.

    Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2012;118:33773386.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914919.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Lawton MP. Scales to measure competence in everyday activities. Psychopharmacol Bull 1988;24:609614.

  • 17.

    Freyer G, Geay JF, Touzet S, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol 2005;16:17951800.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Maione P, Perrone F, Gallo C, et al. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 2005;23:68656872.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Koroukian SM, Xu F, Bakaki PM, et al. Comorbidities, functional limitations, and geriatric syndromes in relation to treatment and survival patterns among elders with colorectal cancer. J Gerontol A Biol Sci Med Sci 2010;65:322329.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Winkelmann N, Petersen I, Kiehntopf M, et al. Results of comprehensive geriatric assessment effect survival in patients with malignant lymphoma. J Cancer Res Clin Oncol 2011;137:733738.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 2000;80:896903.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Overcash JA, Rivera HR Jr. Physical performance evaluation of older cancer patients: a preliminary study. Crit Rev Oncol Hematol 2008;68:233241.

  • 23.

    Cesari M, Kritchevsky SB, Penninx BW, et al. Prognostic value of usual gait speed in well-functioning older people—results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005;53:16751680.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Ostir GV, Berges I, Kuo YF, et al. Assessing gait speed in acutely ill older patients admitted to an acute care for elders hospital unit. Arch Intern Med 2012;172:353358.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85M94.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    White DK, Neogi T, Nevitt MC, et al. Trajectories of gait speed predict mortality in well-functioning older adults: the Health, Aging and Body Composition Study. J Gerontol A Biol Sci Med Sci 2013;68:456464.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Guralnik JM, Ferrucci L, Simonsick EM, et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556561.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Vasunilashorn S, Coppin AK, Patel KV, et al. Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2009;64:223229.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Pavasini R, Guralnik J, Brown JC, et al. Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC Med 2016;14:215.

  • 30.

    Pérez-Zepeda MU, Belanger E, Zunzunegui MV, et al. Assessing the validity of self-rated health with the short physical performance battery: a cross-sectional analysis of the international mobility in aging study. PLoS One 2016;11:e0153855.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Extermann M. Interaction between comorbidity and cancer. Cancer Contr 2007;14:1322.

  • 32.

    Pal SK, Hurria A. Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol 2010;28:40864093.

  • 33.

    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968;16:622626.

  • 35.

    Frasci G, Lorusso V, Panza N, et al. Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 2000;18:25292536.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Grønberg BH, Sundstrøm S, Kaasa S, et al. Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy. Eur J Cancer 2010;46:22252234.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Keller JW, Andreadis C, Damon LE, et al. Hematopoietic cell transplantation comorbidity index (HCT-CI) is predictive of adverse events and overall survival in older allogeneic transplant recipients. J Geriatr Oncol 2014;5:238244.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Tomaka J, Thompson S, Palacios R. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health 2006;18:359384.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Seeman TE, Kaplan GA, Knudsen L, et al. Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol 1987;126:714723.

  • 40.

    Moser A, Stuck AE, Silliman RA, et al. The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance. J Clin Epidemiol 2012;65:11071116.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705714.

  • 42.

    Extermann M. Older patients, cognitive impairment, and cancer: an increasingly frequent triad. J Natl Compr Canc Netw 2005;3:593596.

  • 43.

    Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303308.

  • 44.

    Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992;40:922935.

  • 45.

    Crum RM, Anthony JC, Bassett SS, et al. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 1993;269:23862391.

  • 46.

    Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695699.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Borson S, Scanlan J, Brush M, et al. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000;15:10211027.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    McCarten JR, Anderson P, Kuskowski MA, et al. Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc 2011;59:309313.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Carpenter CR, Bassett ER, Fischer GM, et al. Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the caregiver-completed AD8. Acad Emerg Med 2011;18:374384.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Ghosh A. Endocrine, metabolic, nutritional, and toxic disorders leading to dementia. Ann Indian Acad Neurol 2010;13(Suppl 2):S6368.

  • 51.

    Chew ML, Mulsant BH, Pollock BG, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008;56:13331341.

  • 52.

    Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc 2011;59:14771483.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Pasina L, Djade CD, Lucca U, et al. Association of anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the anticholinergic cognitive burden scale and anticholinergic risk scale: results from the REPOSI study. Drugs Aging 2013;30:103112.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Vega JN, Dumas J, Newhouse PA. Cognitive effects of chemotherapy and cancer-related treatments in older adults. Am J Geriatr Psychiatry 2017;25:14151426.

  • 55.

    Canoui-Poitrine F, Reinald N, Laurent M, et al. Geriatric assessment findings independently associated with clinical depression in 1092 older patients with cancer: the ELCAPA Cohort Study. Psychooncology 2016;25:104111.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Hurria A, Li D, Hansen K, et al. Distress in older patients with cancer. J Clin Oncol 2009;27:43464351.

  • 57.

    Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-1983;17:3749.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58.

    D’Ath P, Katona P, Mullan E, et al. Screening, detection and management of depression in elderly primary care attenders. I: the acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Fam Pract 1994;11:260266.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Jongenelis K, Pot AM, Eisses AM, et al. Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. Int J Geriatr Psychiatry 2005;20:10671074.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Jacobsen PB. Assessment of fatigue in cancer patients. J Natl Cancer Inst Monogr 2004;2004:9397.

  • 61.

    Jacobsen PB, Donovan KA, Weitzner MA. Distinguishing fatigue and depression in patients with cancer. Semin Clin Neuropsychiatry 2003;8:229240.

  • 62.

    Respini D, Jacobsen PB, Thors C, et al. The prevalence and correlates of fatigue in older cancer patients. Crit Rev Oncol Hematol 2003;47:273279.

  • 63.

    Hoffman BM, Zevon MA, D’Arrigo MC, et al. Screening for distress in cancer patients: the NCCN rapid-screening measure. Psychooncology 2004;13:792799.

  • 64.

    Jacobsen PB, Donovan KA, Trask PC, et al. Screening for psychologic distress in ambulatory cancer patients. Cancer 2005;103: 14941502.

  • 65.

    Mitchell AJ. Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol 2007;25:46704681.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66.

    Alexandre J, Gross-Goupil M, Falissard B, et al. Evaluation of the nutritional and inflammatory status in cancer patients for the risk assessment of severe haematological toxicity following chemotherapy. Ann Oncol 2003;14:3641.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67.

    Pressoir M, Desné S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 2010;102:966971.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68.

    Aaldriks AA, Maartense E, le Cessie S, et al. Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 2011;79:205212.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69.

    Aaldriks AA, van der Geest LG, Giltay EJ, et al. Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy. J Geriatr Oncol 2013;4:218226.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 70.

    Boléo-Tomé C, Monteiro-Grillo I, Camilo M, et al. Validation of the Malnutrition Universal Screening Tool (MUST) in cancer. Br J Nutr 2012;108:343348.

  • 71.

    Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999;15:116122.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 72.

    Maggiore RJ, Gross CP, Hurria A. Polypharmacy in older adults with cancer. Oncologist 2010;15:507522.

  • 73.

    Riechelmann RP, Saad ED. A systematic review on drug interactions in oncology. Cancer Invest 2006;24:704712.

  • 74.

    Riechelmann RP, Tannock IF, Wang L, et al. Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst 2007;99:592600.

  • 75.

    Tam-McDevitt J. Polypharmacy, aging, and cancer. Oncology (Williston Park) 2008;22:10521055; discussion 1055, 1058, 1060.

  • 76.

    Berdot S, Bertrand M, Dartigues JF, et al. Inappropriate medication use and risk of falls—a prospective study in a large community-dwelling elderly cohort. BMC Geriatr 2009;9:30.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 77.

    Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009;169:19521960.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 78.

    Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157:15311536.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 79.

    Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163:27162724.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 80.

    American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60: 616631.

    • Search Google Scholar
    • Export Citation
  • 81.

    Croke L. Beers Criteria for inappropriate medication use in older patients: an update from the AGS. Am Fam Physician 2020;101:5657.

  • 82.

    Hanlon JT, Schmader KE, Samsa GP, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992;45:10451051.

  • 83.

    Barry PJ, Gallagher P, Ryan C, et al. START (screening tool to alert doctors to the right treatment)—an evidence-based screening tool to detect prescribing omissions in elderly patients. Age Ageing 2007;36: 632638.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 84.

    Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing 2008;37: 673679.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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