Health Status Screening in Elderly Patients – Is this the Way Forward?
order to develop such an individualised treatment approach, properly designed, dedicated clinical trials are required. The EORTC ETF Group recently published the results of a workshop on clinical trials methodology in older individuals diagnosed with solid tumors. In their conclusion, the authors presented recommendations regarding endpoints of trials designed for seniors and arrived at a consensus on a recommended set of screening tools, including minimum dataset (MinDS), to use as a baseline geriatric assessment in clinical trials. The MinDS includes the G8, IADL and CCI questionnaires as well as a social situation assessment.68
authors recommended these instruments because of their simplicity, comprehensiveness and satisfactory results in clinical validation studies.62
Moreover, CCI and IADL predict mortality, are
well known and widely used, and have been accepted and validated in many studies. Also there is no doubt that all aspects of a patient’s social situation influence the treatment of older patients.68
questions that still need to be answered are: when and how often in the course of treatment should assessment and re-assessment be carried out? How should treatment be modified on the basis of the
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results of geriatric assessment tests? Will patients experience notable benefits that will translate into commonly-used endpoints such as overall survival or quality of life?
Geronto-oncological assessment is not only an important aspect of treatment strategy planning, it can also identify many seemingly insignificant problems, which can be easily eliminated, e.g. dental problems leading to malnutrition or lack of social and psychological support. Moreover, other ailments of old age, such as poor vision and hearing, urinary incontinence and gait and balance impairment30 – which may impede everyday activity causing withdrawal, reluctance to go out and, in effect, social isolation – cannot be ignored. A holistic approach to the treatment and support of elderly patients should be given appropriate consideration. Screening tools, such as those presented in this review, can help clinicians not only to identify seniors’ needs in terms of treatment adaptation and individualisation, but also to optimise the use of human and financial resources without jeopardising the main goal: best treatment and care. n
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