Shared-decision making in older patients with cancer: The added value of frailty screening

Abstract

Achieving an appropriate individualization of treatment in older patients with cancer remains challenging. Identifying someone’s frailty is an important aspect to guide treatment decisions. Frailty can be identified by frailty screening, for instance by the Geriatric 8 (G8) questionnaire, followed by a geriatric assessment if this screening tool has an impaired score. In this thesis, we have addressed important aspects of shared-decision making in older patients with cancer by assessing the predictive value of the G8 for several treatment outcomes, namely postoperative complications, immune-related adverse events caused by immune checkpoint inhibitors, and symptom burden. We concluded that the G8 can be seen as an additional tool in guiding shared-decision making. The G8 not only informs the treating oncologist about whether his patient benefits of a referral to the geriatrician for a geriatric assessment, but the G8 also gives information about whether his patient is at risk for a complicated treatment outcome. In addition, we have provided information about the impact of anti-cancer treatment on two kind of patient-related outcomes (PROs), namely functional decline and symptom burden. Having insight in PROs is very important, since maintaining or improving quality of life and retaining independency have been preferred as relevant outcomes by older patients with cancer. Both the outcome of frailty screening as the impact of a treatment on PROs should be a topic in the conversation with your patient and could guide the shared-decision making process.