The role of the geriatrician in the care of older patients with breast cancer: a review

Cancer is a disease of older age, and with the aging of the population, the number of older patients with cancer will increase. Older cancer patients often present with multiple comorbidities and frailty, resulting in an increased risk of adverse events and loss of function following treatment. Treatment guidelines are based on trials where older patients with frailty and multimorbidity are underrepresented, and usually do not capture relevant endpoints such as retaining of function or quality of life. All of this complicates decision-making for older patients with cancer. Performing a geriatric assessment can aid decision making and management in older cancer patients, and there is increasing evidence supporting the implementation of geriatric assessment (GA) in daily practice. Recently a number of randomized controlled trials have been published on the effect of GA and management on chemotherapy toxicity, showing better outcomes for patients in the intervention group. Several guidelines on cancer management in older patients have also stated the importance of incorporating GA in the work -up and management of older patients with cancer. In this review an overview of the available evidence regarding GA and geriatric co -management for older patients with cancer is provided. How to implement this in daily practice and how to tailor treatment decisions to the older patient with cancer, is described as well. All off these topics are presented for the larger of older with and for older with breast cancer.