Comprehensive geriatric assessment and its clinical impact in oncology - systematic literature review

More than half of new cancer cases are diagnosed in elderly population and despite these data patients 65 years of age or older are poorly represented in the large controlled trials. There is no strong evidence how much these patients benefit from chemotherapy with consecutive risk of adverse events. At the same time one believes that elderly cancer patients are more vulnerable for treatment toxicity as a result of decreased organs reserves, diminished ability to repair cell damages, and altered drug pharmacokinetics, increased drug interactions and comorbidities. Comprehensive Geriatric Assessment (CGA) as the complex and multidisciplinary method allows detecting of numerous clinical, functional, psychological and social problems which might be uncovered during standard clinical procedures. The main outcome of CGA is distinction of three groups of patients: fully independent and fit to receive standard cancer therapy without increased risk of treatment-related toxicity; completely dependent and incapable for cancer treatment and intermediate group of patients who may benefit from cancer therapy but treatment must be tailored to their individual capacity (dose reduction, alternative chemotherapy regimens, elderly friendly chemotherapy).