Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care

Article Tools REVIEW ARTICLES Caring for Older Adults With Cancer Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.21.00143 Journal of Clinical Oncology - published online before print May 27, 2021 PMID: 34043436 Surgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve Care Isacco Montroni, MD, PhD1xIsacco MontroniSearch for articles by this author; Nicole M. Saur, MD2xNicole M. SaurSearch for articles by this author; Armin Shahrokni , MD3xArmin ShahrokniSearch for articles by this author; Pasithorn A. Suwanabol, MD4xPasithorn A. SuwanabolSearch for articles by this author; and Tyler R. Chesney , MD5,6,7xTyler R. ChesneySearch for articles by this author Show More 1Colon and Rectal Surgery, Ospedale “per gli Infermi”, AUSL Romagna, Faenza, Italy2Division of Colon and Rectal Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA3Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY4Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI5Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada6Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada7Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada*I.M. and N.M.S. contributed equally to this work and should be considered as first authors. https://doi.org/10.1200/JCO.21.00143 First Page Full Text PDF Figures and Tables © 2021 by American Society of Clinical OncologyCONTEXTKey ObjectiveHow can I implement in my practice a comprehensive and efficient patient-centered pathway for older patients with cancer undergoing surgery?Knowledge GeneratedAge is just a number and should not guide oncologic care. Every clinical and organizational effort should revolve around measuring functional recovery and patients' quality of life together with oncologic appropriateness. The ideal solution to improve perioperative clinical outcomes in older adults should include a multidimensional, multidisciplinary, and multiphase pathway, rather than a single intervention.RelevanceThis review provides a roadmap prioritizing interventions in a stepwise manner based on importance and ease of implementation, and may be adjusted based on available local resources. We will discuss minimally invasive surgery, enhanced recovery protocols, frailty assessment and geriatric comanagement (including in the palliative setting), prehabilitation, and social frailty.AUTHOR CONTRIBUTIONSConception and design: Isacco Montroni, Nicole M. Saur, Armin Shahrokni, Tyler R. ChesneyCollection and assembly of data: Pasithorn A. Suwanabol, Tyler R. ChesneyData analysis and interpretation: Tyler R. ChesneyManuscript writing: All authorsFinal approval of manuscript: All authorsAccountable for all aspects of the work: All authorsAUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTERESTSurgical Considerations for Older Adults With Cancer: A Multidimensional, Multiphase Pathway to Improve CareThe following represents disclosure information provided by the authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).Isacco MontroniSpeakers' Bureau: Olympus Medical SystemsNo other potential conflicts of interest were reported.