Frailty and quality of life in older adults with cancer

Abstract

Cancer predominantly affects older adults. In the Netherlands, one-third of all patients with cancer is aged 75 years or older and due to aging of the population, this proportion is expected to rise during the upcoming decades. The treatment decision-making process in this group of patients can be challenging. First, knowledge regarding efficacy and safety of cancer treatment for older patients is limited. Second, older patients form a heterogeneous population in which their level of frailty and resilience vary widely. Moreover, older patients have various treatment goals in which maintenance of functional status and quality of life may be just as important as survival benefit. This requires an individualized approach: is a standard treatment possible or is an adapted treatment desirable? This thesis aims to increase the knowledge of geriatric oncology in order to improve tailored made cancer care.

In summary, our results show that estimating frailty can be improved by adding a geriatric evaluation; it assists the identification of potentially frail patients who are at risk of mortality, toxicity or treatment non-completion. Although biological age and patient preferences are considered in the treatment decision-making process, performing a geriatric evaluation remains important in order to tailor cancer care. After all, many individual differences in quality of life after cancer treatment are observed. Those patient related outcomes should be more often included as study objective in future clinical trials to improve the decision-making process in older adults with cancer.