Presentation Points 

Treatment decisions are not supported by evidence in older patients 

  • One third of hematology trials in the NIH registry apply age based restrictions

    (Sher et al JCO 2012)
    • When allowed older patients are not representative of the older patients seen in clinical practice. (Hamaker et al Oncologist 2014)

Integrated approach to assess therapeutic options in older patients that: 

  • Incorporates patient values and preferences… 
    • «Appropriate effort should be made to assess an older patient’s capacity to make a treatment decision before deeming them to lack that capacity and be in need of a surrogate decision maker (eg. care giver).  
    • Efforts should be made to support the patient in overcoming his limitation. This supported decision making as referenced by the United Nations Convention on the Rights of Persons with Disabilities can come in many forms depending on the specific deficit identified» (DuMontier et al, Sommerlatte et al JCO Sep 2021)
  • [Revists] the concept of frailty and geriatric assessment 
    • Frailty assessment included in MM guidelines 
    • Frailty assessment is incorporated in CLL guidelines 
      • The treatment decision should include an assessment of IGHV and TP53 status, as well as patient-related factors such as comedication, comorbidities, preferences, drug availability and potential of treatment adherence. (Eichorst B et al Ann Oncol 2020)