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Aging and disease
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Management of The Elderly Cancer Patients Complexity: The Radiation Oncology Potential
Giuseppe Colloca1,3,*, Luca Tagliaferri1, Beatrice Di Capua1,3, Maria Antonietta Gambacorta1, Vito Lanzotti1, Andrea Bellieni2,3, Silvio Monfardini4, Lodovico Balducci5, Roberto Bernabei2, William C. Cho6, Vincenzo Valentini1
1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy.
2Istituto di Medicina Interna e Geriatria, Università Cattolica Sacro Cuore, Roma, Italy.
3GIOGER Gruppo italiano di Oncologia Geriatrica, Italy.
4Geriatric Oncology Program Istituto Palazzolo, Milano, Italy.
5Senior Adult Oncology Program Moffitt Cancer CenterTampa, USA
6Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong.
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Radiation oncology has the potential to be an excellent option for the frail elderly cancer patients because of its limited systemic toxicities. It can be effective for curative, prophylactic, disease control or palliative purposes. Currently about 60% of all cancer patients undergoing active treatment at some point receive radiation treatment. However, though widely used, there are limited clinical trials strictly designed for the elderly. This paper will review the key points in the assessment and treatment of elderly cancer patient including quality of life, active life expectancy, cognitive performance, frailty, sarcopenia and how the new technologies can help to reach the key goal of maintaining autonomy and independence for the elderly cancer patient.

Keywords radiation oncology      elderly      cancer      frailty      quality of life      sarcopenia      complexity      personalized treatment     
Corresponding Authors: Giuseppe Colloca   
Just Accepted Date: 19 November 2019  
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Giuseppe Colloca
Luca Tagliaferri
Beatrice Di Capua
Maria Antonietta Gambacorta
Vito Lanzotti
Andrea Bellieni
Silvio Monfardini
Lodovico Balducci
Roberto Bernabei
William C. Cho
Vincenzo Valentini
Cite this article:   
Giuseppe Colloca,Luca Tagliaferri,Beatrice Di Capua, et al. Management of The Elderly Cancer Patients Complexity: The Radiation Oncology Potential[J]. Aging and disease, 10.14336/AD.2019.0616
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Figure 1.  Comparison between successful aging, organ failure, fragility, cancer.

Social status
MOS Social Activity Survey
Caregiver burden
MultimorbidityCharlson Comorbidity Index
CIRS CIRS-G Number of comorbid conditions Simplified Comorbidity Score Summary of comorbidities
Functional statusADL: Katz index
IADL: Lawton scale Performance status index Barthel Index Pepper Assessment Tool for Disability Visual and/or hearing impairment, regardless of use of glasses or hearing aids MOS physical Health (any version) Mobility Problem (requiring help or the use of a walking aid) Timed Get Up and Go Hand grip strength Short Physical Performance Battery One-leg standing balance test Gait speed
CognitionMMSE (any version)
Montreal Cognitive Assessment (MoCA) Informant Questionnaire on Cognitive Decline in the Elderly Clock-drawing test Blessed Orientation-Memory-Concentration Test
Center for Epidemiologic Studies Depression Scale HADS Mental Health Index The distress thermometer
MNA Short nutritional assessment questionnaire
PolypharmacyBeers criteria
STOP and START criteria
Table 1  Instrument used to perform geriatric assessment in oncological patients.
Phisical performance (is he/she fit, frail, pre-frail?)
Cognitive performance (needs for cognitive assessment?)
Active life expenctancy
Quality of life (individual needs and will)
The enviroment (the social cloud around the patient is able to allow the treatment?)
Table 2  Key points to assess before decision making in elderly cancer patients.
Figure 3.  Flow Chart: Decision making in radiation oncology on elderly cancer patients. For supportive care we mean those cares focuse on preventing and treating symptoms or any complication due to cancer or therapies, during oncological treatment. For palliative care we mean a multidisciplinary approach dedicated to patients with life-threatening illness no longer treatable for cancer, that prevent and relief physical, psychosocial and spiritual sufferings.
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