European journal of cancer : official journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)
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Comprehensive geriatric assessment (CGA) is a process that consists of a multidimensional data-search and a process of analyzing and linking patient characteristics creating an individualized intervention-plan, carried out by a multidisciplinary team. In general, the positive health care effects of CGA are established, but in oncology both CGA and the presence of geriatric syndromes still have to be implemented to tailor oncological therapies to the needs of elderly cancer patients. In this paper the conceptualization of geriatric syndromes, their relationship to CGA and results of clinical studies using CGA in oncology are summarized. ⋯ Functional performance scores and dependency at home appeared to be independent predictive factors for toxicity, similar to depressive symptoms and polypharmacy. Overall, CGA implements/collects information additional to chronological age and Performance Score. So far in oncology there are no prognostic validation studies reported using geriatric syndromes or information based on CGA in its decision making strategies.
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With increasing life expectancy, the number of very elderly patients requiring surgery and anaesthesia is increasing. Age, co-morbidity and altered pharmacokinetics clearly need to be considered in assessment of surgical risk but even in the apparently well older person there is a loss of physiological reserve that may be overlooked on cursory examination. Cognitive impairment after surgery may seriously hinder older people. This paper looks at these factors in detail and provides some remedies.