NCCN Updates Treatment Guidelines for Older Adults With Cancer

06/13/18

The National Comprehensive Cancer Network (NCCN) has released updated guidelines for older adult patients, including new additions for pre-treatment evaluation as well as considerations for surgery, radiation, and systemic therapy.

The pre-treatment evaluation algorithm was revised extensively to account for changes in the sections “Considerations for Older Adults Undergoing Cancer Treatments” and “Geriatric Screening Tools.” The latter section is an entirely new page in the guidelines.

The section “Considerations for Older Adults Undergoing Cancer Treatments” was also revised extensively. Under the subcategory for surgery, a new footnote was added for patients undergoing general surgery: “The American College of Surgeons and the AGS have provided general guidelines for the preoperative assessment of older patients undergoing surgery. These guidelines could also be applied to older patients with cancer undergoing surgery.” A citation for this footnote was provided (J Am Coll Surg; 2012;215:453-466).

The subcategory for radiation therapy was also modified. It now reads, “Considerations for older patients undergoing radiation therapy will heavily depend on the anatomic site being radiated and the dose/fractionation chosen. Use caution with concurrent chemoradiation therapy; dose modification of chemotherapy may be necessary. See disease specific NCCN Guidelines for Treatment of Cancer by site.”

In the section for comprehensive geriatric assessment, the disease-specific issues related to age have been removed. The cancer types are being incorporated into their corresponding guideline for treatment of cancer by site. As of now, the colon and rectal cancer guidelines have incorporated issues related to age in their respective guidelines.

In the comprehensive geriatric assessment subsection for collaboration with oncologists, a bullet was modified to read, “Presence of geriatric syndromes such as frailty, osteoporosis, depression, pressure ulcers, urinary incontinence, neglect or abuse, failure to thrive, or sarcopenia.”

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As for functional status in this same section, there is a new addition to the page: “Comprehensive geriatric assessment includes assessment tools to predict the functional age of older patients with cancer based on functional status, comorbidities that may interfere with cancer treatment, polypharmacy, nutritional status, cognitive function, psychological status, and socioeconomic issues.” In regard to socioeconomic issues, the text “poor living conditions, no caregiver or limited social support, low income, transportation barriers/access problems, under-insurance and/or high out-of-pocket costs for medications” is also new to the page.

In the subsection for comorbidities, the modifications are for those that may increase risk factors from cancer treatment. Included in the list are cardiovascular disease, renal insufficiency, neuropathy, anemia, osteoporosis, liver disease, hearing or vision loss, prior cancer diagnosis and treatment, chronic infections, and decubitus or pressure ulcers.—Zachary Bessette