By 2030, the number of patients aged 65 years and older is expected to double. With aging comes an increased cancer incidence, and more than 60% of all cancers occur in individuals aged 65 years and older. Attendant to this aging explosion are physiologic changes that sometimes result in decreased cognition and physical functioning.1 It is also well established that the underlying health status, and not the chronologic age, determines a patient’s ability to tolerate medical or surgical treatment. Many older patients may retain both sufficient physical and cognitive reserve to successfully complete chemotherapy, radiation therapy, and surgical treatment, despite their chronologic age. For example, the life expectancy of a healthy 80-year-old woman is approximately 10 years,2 and therefore serious consideration should be given to providing cancer therapy to these patients. Tools that can assist oncologists in predicting mortality and morbidity among older prospective treatment candidates should therefore be incorporated into the clinical plan of care.
The Comprehensive Geriatric Assessment (CGA) is one such tool that can be recruited within the geriatric oncology domain to assess functional status (cognitive and physical), nutritional status, impact of comorbid conditions, and degree of social support.3-5 The CGA summarily augments the ability of medical providers to choose appropriate treatment modalities tailored to each older patient diagnosed with cancer. Undoubtedly, older individuals with cancer must be able to navigate complex cancer treatment and communicate with their treatment providers about toxicities of treatment if and when they occur. This article outlines the evidence, including that from the literature, that provides guidance on how to assess cognitive function and decisional capacity in older individuals with cancer.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. This work was supported by the National Cancer Institute at the National Institutes of Health (1K01CA134554-05 to JMM).
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