Critical reviews in oncology/hematology
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Crit. Rev. Oncol. Hematol. · May 2003
ReviewThe frailty syndrome: a critical issue in geriatric oncology.
Evidence exists that the geriatric intervention guided by Comprehensive Geriatric Assessment (CGA) has positive effects on a number of important health outcomes in frail older patients. Although a number of observational studies, editorials, special articles and clinical reports, suggest that CGA should be used to guide the assessment and clinical decision-making in older cancer patients, there is limited support to this view in the literature. Older patients that are diagnosed with cancer are usually healthier and less problematic than persons of the same age who are randomly sampled from the general population. ⋯ The concept of the frailty syndrome, characterized by high susceptibility, low functional reserve and unstable homeostasis, has recently received a lot of attention by the geriatric community. A CGA approach, which also evaluates elements of the frailty syndrome, may be of great interest for those oncologists who want to identify older patients likely to develop severe toxicity and severe side effects in response to aggressive treatment. Improvements in the definition of the frailty syndrome may profit from the clinical experience of oncologists.
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Anesthesia for breast cancer surgery in the elderly requires a specific approach, taking into account physiological and psychological alterations secondary to aging. Breast surgery is a low specific risk surgery, and perioperative risk is mainly dependent of the presence and severity of co-morbidity. It may be reduced by careful evaluation and stabilization of concurrent diseases, at best done through a multidisciplinary approach. In view of anesthetic technique adjustment to medical condition, most geriatric patients may undergo breast cancer surgery with a low incidence of perioperative complications.