Sarcopenia in cancer: Risking more than muscle lossSarcopenia is characterised by progressive and extensive skeletal muscle degeneration and is associated with functional decline. Sarcopenia has primary and secondary aetiology, arising as a result of the ageing process or through chronic cytokine-mediated inflammation (associated with health conditions including cancer), respectively. Diagnosis of sarcopenia is dependent upon detection of reduced skeletal muscle strength, mass and performance. A combination of non-radiological and radiological methods can be used to assess each of these in turn to accurately diagnose sarcopenia.
Supporting older people with cancer, implementing geriatric oncology in the radiotherapy settingRising life expectancy is perhaps the single most powerful metric charting the successes of modern living. Our ageing population is testament to better healthcare but simultaneously one of medicine’s greatest challenges. In this special geriatric oncology in radiotherapy edition of TipsRO, we have invited papers exploring the care of older adults with cancer across multiple elements of the radiotherapy treatment pathway. This edition augments the already growing recognition within the global radiation oncology community that we must urgently seek to improve outcomes for older adults with cancer who may benefit from radiotherapy.
Practical brachytherapy solutions to an age-old quandaryThe World Health Organisation forecasts a doubling of the current population aged above 60 by 2050 meaning this cohort will make up 22% of the total global populace . Concurrently, the burden of cancer in the ageing population has increased considerably and will continue to do so in the future posing a unique global healthcare challenge [2,3]. With increasing life expectancy and delayed presentation and diagnosis, due in part to cancer screening ineligibility, older patients with locally advanced disease will represent a greater proportion of patients seen in cancer clinics.
Personalised treatment for older adults with cancer: The role of frailty assessmentMaking treatment decisions for those who are older often proves difficult, as there is a significant lapse in evidence-based radiation oncology. Older adults are under-represented in clinical trials [1–4], despite the incidence of cancer in this age group, estimated to be 60% of all cancer cases . Studies have highlighted the lack of adherence to standard guidelines for older adults , although, in reality, guidelines are limited, due to the aforementioned lack of trials in older age groups.
Developing an electronic geriatric assessment to improve care of older adults with cancer receiving radiotherapyOlder adults make up a substantial proportion of patients diagnosed with cancer. Gaps in evidence of care for older adults with cancer leads to treatment heterogeneity and poor outcomes. Medical and Surgical Oncology clinics throughout the world are increasingly using Geriatric Assessment (GA) based approaches to treatment that are beginning to improve care through treatment decision-making communication, health-related quality of life outcomes, and reducing chemotherapy toxicities. Yet, GA based approaches are not often used in radiation oncology clinics.
Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, AustraliaLarge non-age-specific radiotherapy utilisation rate (RTU) studies have demonstrated that actual RTU is below the optimal recommended utilisation rate for both curative and palliative intent radiotherapy indications. The optimal utilisation rate for the geriatric oncology cohort of patients has not yet been determined. The purpose of this research was to examine the actual RTU for patients treated in New South Wales (NSW), Australia as a function of increasing age, and the relationship between RTU and tumour site, travelling distance and socio-economic status.