The Effect of a Geriatric Oncology Clinic on Treatment Decisions in Mexican Older Adults With Cancer

OBJECTIVES: Geriatric assessment and interventions improve the care of older adults with cancer, but their effect on treatment decision making in resource-limited settings is unknown. We studied the effect of recommendations made by a consultative geriatric oncology clinic on treatment decision making by oncologists in Mexico. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of 173 consecutive patients with solid tumors referred before treatment initiation to the geriatric oncology clinic at a third-level public hospital in Mexico City between March 2015 and October 2017. Patients were evaluated by a multidisciplinary geriatric oncology clinic, and treatment recommendations were issued to treating oncologists. MEASUREMENTS: We determined the overall proportion of agreement between geriatric oncology recommendations and oncologists' treatment decisions. We assessed whether agreement increased when geriatric oncology recommendations were acknowledged in the treating oncologist's clinic note. The homogeneity of agreement was tested using the Stuart-Maxwell test. RESULTS: Median age was 79 years (range = 64-97 years). "Standard treatment" was recommended in 48% of cases, followed by "less intensive treatment" in 32%, and "best supportive care" in 20%. The overall proportion of agreement for the entire population was 80% (kappa = 0.69), although agreement was heterogeneous (X(2) = 8.16, P = .02). Geriatric oncology recommendations were acknowledged in the treating oncologists' notes in 62% of cases. Overall agreement was higher when the evaluation was acknowledged (83%, kappa = 0.74) than when it was not acknowledged (74%, kappa = 0.60). Agreement was homogeneous only when recommendations were acknowledged in the oncologist's note (X(2) = 3.0, P = .22). CONCLUSIONS: The overall proportion of agreement between geriatric oncology recommendations and final treatment decisions was high, particularly when recommendations were acknowledged in the treating oncologists' note. Including geriatric oncology evaluations in everyday clinical practice and fostering interdisciplinary communication between geriatric oncology and treating oncologists may provide valuable guidance for physicians caring for older patients with cancer in resource-limited settings. J Am Geriatr Soc 67:992-997, 2019

The ecology of cancer

Neoplasia, the disease of multicellular organisms, is not only a major cause of human death worldwide but also affects numerous invertebrate and vertebrate species. Similar to other diseases, cancer is a significant physiological burden on the host and hence not only impacts the individual but also influences interindividual interactions, populations and consequently global ecosystems. Despite this, oncology and other biological sciences such as ecology and evolution have until very recently developed in relative isolation. To overcome this caveat, we draw parallel between invasive species and the metastatic cascade and provide an overview of the ecology of cancer at the scale of the organisms and the ecosystems of malignant cells (both at the micro- and macro-scales). We discuss the drivers of metastatic formations in the tissue environment and investigate how individuals respond to malignant growth and the impact of this response on populations. Finally, we provide potential avenues for applying evolutionary ecology principles to cancer prevention and to the development of novel treatment strategies