Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers
Simple Summary
Abstract
1. Introduction
2. Methods
3. Oncogeriatric Evaluation Specific to the Non-Colorectal Digestive Cancers, Decision Support
3.1. Identifying Frail Patients
3.2. Comprehensive Geriatric Assessment (CGA)
3.2.1. Loss of Autonomy and the Role of the Caregiver
3.2.2. Malnutrition
3.2.3. Walking and Muscle Function
3.2.4. Cognitive Disorders
3.2.5. Thymic Assessment
3.2.6. Impact of Comorbidities
3.2.7. Therapeutics in Onco-Geriatrics: Limiting Polypharmacy, Iatrogenesis, and Drug Interactions
4. Support for Surgical Care
4.1. Preoperative Optimization
4.1.1. Prognostic Evaluation of Surgical Risks Through Geriatric Assessment
4.1.2. Prehabilitation
The Emergence of Prehabilitation
What Type of Prehabilitation?
- Adapted physical activity
- 2.
- Nutritional management
- 3.
- Psychological care
Prehabilitation Duration
Population and Efficacy of Prehabilitation
4.2. Post-Operative Co-Management
4.2.1. Co-Management Between Surgeons and Geriatricians: Impact on Mortality and Surgical Complications
4.2.2. Fast-Track Surgery
4.2.3. Post-Operative Delirium: Prevention and Management
- Detecting pre-existing cognitive disorders.
- Limiting iatrogenicity: this involves restricting the prescription of certain medications that may contribute to confusion, such as anticholinergic drugs, certain painkillers, such as tramadol or meperidine, and psychotropic drugs.
- Ensuring proper correction of any sensory impairments and reorientation.
- Addressing sleep disorders, including sleep apnoea syndromes.
- The other three points overlap with ERAS: Managing transit or urinary disorders, encouraging early postoperative walking and providing technical aids if necessary, and managing pain.
- Prefer the use of a single medication, chosen based on the specific symptoms of the patient.
- Administer the medication at the lowest effective dose.
- Prefer oral administration whenever possible.
- Choose medications with the least anticholinergic effects possible to mitigate potential cognitive side effects.
5. Support for Systemic Treatments Management
5.1. Toxicity of Systemic Treatments in Older Patients with Digestive Cancers
5.2. Co-Management Between Oncologists and Geriatricians
6. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Large Language Model Statement
References
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Molecules | Main Toxicities | Comorbidities to Look For | Geriatric Outcomes | Recommended Course of Action |
---|---|---|---|---|
OXALIPLATINE | Neuropathic | Diabetes, narrow lumbar canal, other causes of neuropathy | Increased falls, functional decline, need for assistance with dressing and grooming | ↓ dose, stop |
Infections | Home aids, remote alarm, physiotherapy, technical aids | |||
Hematologic | Hemopathy, low bone marrow reserves | Anaemia: falls, cardiac decompensation, loss of autonomy | ↓ dose | |
Infections, falls, wounds | Influenza/COVID/pneumococcal vaccination | |||
Erythropoietin | ||||
Digestive | Nutrition | Weight monitoring, dietary management, caregiver education | ||
5-FLUOROURACIL | Coronary spasm | Severe unstable coronary artery disease | Cardiologic advice | |
Transit disorders | Incontinence, gait disorders | Risk of falls, undernutrition | ↓ dose, ↓ bolus | |
Risk of dehydration | Perforated chair, protection, hydration, dietary care | |||
Hand-foot syndrome | Gait disorders | Risk of falls, loss of autonomy (dressing, cooking) | ↓ dose | |
Implementation of aids | ||||
TAXANES | Neuropathic | Diabetes, narrow lumbar canal, other causes of neuropathy | Increased falls, functional decline, need for assistance with dressing and grooming | ↓ dose, stop |
Home aids, remote alarm, physiotherapy, technical aids | ||||
BEVACIZUMAB | High blood pressure | High blood pressure, heart failure | Risk of decompensation of cardiovascular comorbidities | Monitoring of blood pressure and weight |
Proteinuria | Renal insufficiency | |||
Thrombosis and haemorrhage | History of thrombosis, anticoagulant, valve prosthesis | Discuss low-molecular-weight heparin LMWH if direct oral anticoagulant (DAO)or Vitamin K antagonist VKA | ||
Healing disorders | Unscheduled surgery for comorbidity | Cancel or differ scheduled non-urgent surgery | ||
IRINOTECAN | Transit disorders | Incontinence, gait disorders | Increased falls | ↓ dose, stop |
Risk of dehydration and malnutrition | Wardrobe chair, diapers, incontinence briefs, hydration, dietary management | |||
Medullary | Hemopathy, low bone marrow reserves | Infections | Influenza/COVID/pneumococcal vaccination | |
Anaemia: falls, cardiac decompensation, loss of autonomy | Erythropoietin | |||
Providing Human assistance | ||||
NIVOLUMAB | Asthenia | General condition | Loss of autonomy | Adaptation of aids |
PEMBROLIZUMAB | Rash | Xerosis, pruritus | Pruritus, wounds | Emollient, antihistamines (avoid hydroxizine-type anticholinergics due to cognitive and urinary risk) |
Diarrhoea | Incontinence, walking disorders | Increasing falls, risk of dehydration | Remote alarm, therapeutic education for patient or caregiver | |
Walking difficulties | ||||
Arthralgia | Osteoarthritis, polymyalgia rheumatica, rheumatoid arthritis | Analgesia, rheumatologic advice, technical aids, remote alarm | ||
Thyroid dysfunction | Cognitive impairment | Increased cognitive impairment, heart disease | Endocrinologist advice | |
ATEZOLIZUMAB | Asthenia | Cardiopathy | Loss of autonomy | See above |
Pruritus | ||||
Arthralgia | ||||
Nausea |
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Aregui, A.; Estrada, J.; Lefèvre, M.; Carteaux-Taieb, A.; Beraud-Chaulet, G.; Hammel, P.; Fossey-Diaz, V.; Aparicio, T. Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers. Cancers 2025, 17, 1589. https://doi.org/10.3390/cancers17091589
Aregui A, Estrada J, Lefèvre M, Carteaux-Taieb A, Beraud-Chaulet G, Hammel P, Fossey-Diaz V, Aparicio T. Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers. Cancers. 2025; 17(9):1589. https://doi.org/10.3390/cancers17091589
Chicago/Turabian StyleAregui, Amélie, Janina Estrada, Madeleine Lefèvre, Anna Carteaux-Taieb, Geoffroy Beraud-Chaulet, Pascal Hammel, Virginie Fossey-Diaz, and Thomas Aparicio. 2025. "Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers" Cancers 17, no. 9: 1589. https://doi.org/10.3390/cancers17091589
APA StyleAregui, A., Estrada, J., Lefèvre, M., Carteaux-Taieb, A., Beraud-Chaulet, G., Hammel, P., Fossey-Diaz, V., & Aparicio, T. (2025). Geriatric Assessment and Management, Prehabilitation and Rehabilitation for Older Aldults with Non-Colorectal Digestive Cancers. Cancers, 17(9), 1589. https://doi.org/10.3390/cancers17091589