Letter to the Editor
Addressing the challenges of cancer care in older adults: The unique benefits of oncogeriatric evaluation and management
Afrontando los desafíos de la atención del cáncer en adultos mayores: los beneficios únicos de la evaluación y manejo oncogeriatra
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class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Raul" "apellidos" => "Cordoba" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Bernadette" "apellidos" => "Fang" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Regina" "apellidos" => "Girones" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Geriatrics Department, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos, 28922 Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Coordinación Sociosanitaria, Consejería de Sanidad, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital La Fe, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Afrontando los desafíos de la atención del cáncer en adultos mayores: los beneficios únicos de la evaluación y manejo oncogeriatra" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Age is the single major risk factor for most cancers, including hematological malignancies, with population aging posing a growing concern worldwide. In Europe, the median age at diagnosis for hematological malignancies is 69 years; incidence increases with age, reaching a maximum at 75–99 years.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Survival for patients aged 75 years and older with hematological malignancies is generally poor, particularly for those with acute leukemias. The incidence of solid tumors also increases with age, with the presence of frailty, malnutrition and comorbidities associating a higher risk for mortality in elderly patients diagnosed with cancer.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Understanding outcome variability, treatment challenges, and the impact of frailty and comorbidities among older patients is of utmost importance if we are to manage the burden of cancer in the aging population correctly.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Along with the aging population, the increasing cost of oncological treatments is another major challenge that healthcare systems face today. Strategies developed to minimize the impact of these challenges include promoting the use of generic and biosimilar medications, negotiating drug prices, evaluating the cost–benefit profile of different treatments, promoting the prevention and early diagnosis of cancer, and optimizing access to therapy. The judicious use of digital health tools merits special attention, as studies demonstrate improved cancer care outcomes and reduced costs<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>; digital health interventions for older patients with cancer have shown to improve clinical outcomes<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and increase access to care, especially in patients with reduced mobility. A careful design, taking care to bridge the “digital divide”, is vital to the success of digital health interventions for geriatric patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the context of population aging and budget constraints, geriatric oncology could be the key to addressing the unique challenges presented by cancer treatment in older patients, and fundamental to patients’ quality of life and survival.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Geriatric oncology focuses on cancer treatment in older people and uses comprehensive geriatric assessment to develop personalized treatment plans tailored to patients’ individual needs. The Community of Madrid's Plan for the Attention of Frailty and Healthy Aging<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> prioritizes the early detection of frailty in those clinical processes in which frailty could reduce treatment tolerance or put patients at risk for functional decline. Unfortunately, the widespread implementation of geriatric oncology programs is yet to be achieved, despite multiple arguments which justify the benefits of such an approach.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall">Geriatric oncology programs permit personalized care by developing individualized treatment plans depending on each patient's needs, thus avoiding unnecessary treatments and ensuring that patients receive an appropriate and effective treatment according to their health status and therapeutic tolerance.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">Geriatric oncology programs (GOPs) reduce direct spending on oncology treatments, as well as costs associated with ineffective therapy and avoidable side effects.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">GOPs improve patients’ quality of life through comprehensive care and geriatric evaluation, which reduce the morbidity and mortality associated with cancer in older patients.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">GOPs increase access to care by implementing technological advances such as telemedicine to provide support for patients with limited mobility.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">GOPs address the aging population. With the increase in life expectancy, the incidence of cancer in older people is expected to rise, highlighting the need to ensure that older patients receive appropriate and personalized treatment.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">GOPs contribute to healthcare system sustainability by reducing cancer treatment-associated costs in older patients.</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Multiple publications underline the need for implementing geriatric programs for older patients with cancer, demonstrating the efficacy of comprehensive geriatric evaluation for these patients though outcomes such as improved quality of life, reduced healthcare spending, and reduced prescription of unnecessary oncology treatments.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Some countries, such as France and the UK,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> have modified cancer care policies in patients over 70 to include comprehensive geriatric evaluation and personalized care, with results including improved quality of life and reduced direct healthcare spending.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In summary, there are overwhelming arguments to convince healthcare services of the need for geriatric oncology programs. Healthcare managers cannot ignore this need if the sustainable improvement of cancer care in older adults is truly a priority. Geriatric oncology offers a personalized model of care tailored to the needs of each patient, reducing spending on oncology treatment, improving patients’ quality of life, providing solutions to address population aging, and contributing to the sustainability of the healthcare system.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implementation of geriatric haematology programmes for the treatment of older people with haematological malignancies in low-resource settings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Soto-Perez-de-Celis" 1 => "J. Martínez-Peromingo" 2 => "Y. Chávarri-Guerra" 3 => "K. Poh Loh" 4 => "R. 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