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Background. We investigated whether a brief geriatric assessment (GA) would identify important patient deficits that could affect treatment tolerance and care outcomes within a sample of older cancer patients rated as functionally normal (80%–100%) on the Karnofsky performance status (KPS) scale. Methods. Cancer patients aged ≥65 years were assessed using a brief GA that included both professionally and patient-scored KPS and measures of comorbidity, polypharmacy, cognition, function, nutrition, and psychosocial status. Data were analyzed using descriptive statistics and multivariable logistic regression. Results. The sample included 984 patients: mean age was 73 years (range: 65–99 years), 74% were female, and 89% were white. GA was conducted before (23%), during (41%), or after (36%) treatment. Overall, 54% had a breast cancer diagnosis (n = 528), and 46% (n = 456) had cancers at other sites. Moreover, 81% of participants (n = 796) had both professionally and self-rated KPS ≥80, defined as functionally normal, and those patients are the focus of analysis. In this subsample, 550 (69%) had at least 1 GA-identified deficit, 222 (28%) had 1 deficit, 140 (18%) had 2 deficits, and 188 (24%) had ≥3 deficits. Specifically, 43% reported taking ≥9 medications daily, 28% had decreased social activity, 25% had ≥4 comorbidities, 23% had ≥1 impairment in instrumental activities of daily living, 18% had a Timed Up and Go time ≥14 seconds, 18% had ≥5% unintentional weight loss, and 12% had a Mental Health Index score ≤76. Conclusion. Within this sample of older cancer patients who were rated as functionally normal by KPS, GA identified important deficits that could affect treatment tolerance and outcomes.

There are currently 33 million cancer survivors worldwide. With improvements in early cancer detection and treatments, patients are living longer - and it is well-recognized that many survivors develop short- and long-term physical, psychosocial and spiritual effects as a result of their diagnoses and treatments. There is increasing awareness of the importance of using patient-reported outcomes (PROs) to accurately assess these effects in cancer survivors. Validated patient-reported outcome instruments: Traditionally, physicians have assessed the acute and late side effects of cancer treatments with standardized scales such as the CTCAE. However, multiple studies have demonstrated that PROs more accurately capture patient symptoms than physician assessment. In this article we describe frequently used, validated, general and cancer-specific PRO instruments that assess symptoms. We describe additional PRO instruments that assess unmet needs, interpersonal relationship issues, and psychosocial and financial problems. Published studies using these instruments have identified issues commonly faced by cancer survivors worldwide. Discussion and summary: While PROs are increasingly used in research, further efforts are needed to integrate PRO assessment into routine clinical care, so that timely and accurate assessments can translate into better management of issues - ultimately improving the lives of cancer survivors.

Objective Sarcopenia is the age-related loss of muscle mass, strength, and function. It is a common finding in older patients and is associated with decreased life expectancy and potentially higher susceptibility to chemotherapy toxicity. This study describes the prevalence of sarcopenia in older adults with early stage colorectal cancer. Materials and Methods Patients ≥ 70 years old who underwent surgical resection for stage I–III colorectal cancer between 2008 and 2013 were identified from the medical record. Sarcopenia was assessed by measuring the total muscle area on computerized tomography (CT) images obtained prior to surgery. Total muscle area was measured at the level of L3 and normalized using each patient’s height to produce a skeletal muscle index (SMI). Sarcopenia was defined using sex- and body mass index (BMI)–specific threshold values of SMI. Results Eighty-seven patients were included, with a median age of 77 years (70–96). Twenty-five men (60% of 42) and 25 women (56% of 45) had sarcopenia. Sarcopenic patients had significantly lower BMI ( p = 0.03) compared to non-sarcopenic patients. There was a positive correlation between BMI and SMI for both men ( r = 0.44) and women ( r = 0.16). Conclusion Sarcopenia is highly prevalent among older patients with early stage colorectal cancer. BMI alone is a poor indicator of lean body mass and improved methods of screening for sarcopenia are necessary. CT scans are a viable option for identifying sarcopenic patients in whom timely interventions may improve survival, quality of life, and functional outcomes.

With the aging of the American population, the incidence of new cancer diagnoses is projected to increase 45% from 2010 to 2030 (1). Coupled with the growing proportion of cancer patients who are cured (2), we face a new challenge: a large population of aging cancer survivors (3). Long-term survivors of childhood and adult cancer can exhibit substantial late sequelae, including endocrine dysfunction, cognitive impairment, cardiovascular morbidity, secondary neoplasms, and neuromuscular impairment (4–8). Little is known about how chemotherapy causes long-term adverse effects and whether it alters the pace of physiologic aging. Human aging is characterized by a steady decline in organ function, which leads to loss of physiologic reserve and frailty (9). This loss of function is characterized by a decline in the replicative capacity of certain self-renewing cells and the accumulation of cells that have undergone cellular senescence (10,11). Cellular senescence is triggered by the activation of tumor-suppressor mechanisms in response to varied cellular stresses such as oncogene activation, tissue injury, telomere dysfunction, and persistent DNA damage. Senescence is strongly associated with activation of the INK4/ARF (CDKN2a) locus on human chromosome 9p21.3, which encodes the p16INK4a and ARF tumor suppressor proteins. Several lines of evidence suggest senescence influences mammalian aging: 1) expression of p16 INK4a increases exponentially with chronological aging (12–14) and causes reduced replicative capacity of some cell types (15–19); 2) regulatory polymorphisms of senescence regulators (eg, CDKN2a and TERT) have been linked through unbiased genome-wide studies with many age-associated conditions such as cancer, pulmonary fibrosis, atherosclerosis, and type II diabetes (20); and 3) therapies to decrease the production of or increase the clearance of senescent cells in mice ameliorate certain age-associated phenotypes (21–23). Because of the intimate links between senescence and aging, markers of cellular senescence, including leukocyte telomere length (LTL), expression of senescence-associated (SA) cytokines such as interleukin 6 (IL-6), and expression of INK4a/ARF transcripts, have been tested as potential biomarkers of molecular aging. Decreased LTL has been linked with chronological age and age-promoting stressors such as cigarette smoking in several studies in human populations (24–26). Senescent cells elaborate a host of potent cytokines (ie, the senescence-associated secretory phenotype) (27), which promote a proinflammatory tissue microenvironment. Expression of SA-cytokines, such as IL-6, has been reported to increase with aging and to predict age-associated morbidities and mortality (28–32). More recently, expression of p16 INK4a, and to a lesser extent ARF, in defined tissues such as peripheral blood T cells (PBTLs) have been described as biomarkers of aging. Using the p16 INK4a assay, we have shown that smoking, physical inactivity, and chronic human immunodeficiency virus infection accelerate expression of this biomarker of molecular age in the PBTL compartment (14,33). Given the apparent long-term toxicities of DNA-damaging agents, we sought to determine whether cytotoxic chemotherapy given with curative intent accelerates molecular aging in humans.

Objective Emerging results support the value of geriatric assessment (GA) in determining the risk and benefits of cancer treatment in older adults. A brief GA tool consisting of valid and reliable measures has been developed; however, little data exist on the ability to perform the GA in community oncology clinics. The objective of this study was to determine the feasibility of performing the GA in the community. Materials and Methods Patients aged ≥ 65 were eligible. The GA included a health care provider assessment of performance status, cognitive function, a Timed Up and Go test, and a self-administered patient questionnaire that evaluated measures of functional status, comorbidity, psychological state, social support, and nutritional status. Results From 2009 to 2013, 1088 patients were assessed including 339 (31%) from seven community clinics across North Carolina. The median amount of time to complete the patient-report portion of the GA was 19 min in the academic center versus 22 min in the community. The median amount of time to complete the entire GA was 23 min in the academic center and 30 min in community settings. Significantly more patients in the community required assistance completing the questionnaire (24% vs. 14%); however, most patients required no assistance (76%). Conclusion A brief GA can be performed in community oncology clinics. The time to complete the professional assessments and patient self-assessments were similar in both settings. Future studies are planned to determine if such assessments can improve cancer care for older patients.