Optimizing the geriatrician's contribution to cancer care for older patients.

Cancer specialists and geriatricians can struggle to find the best form for their collaboration within geriatric oncology and do not always benefit optimally from the experience and knowledge the other has to offer. To optimize the yield of a geriatric consultation for older patients with cancer, the geriatrician needs to know the specific purpose of the consultation, the expected disease trajectory, and some information on the potential benefits and risks of treatment options including best supportive care only. The geriatrician should subsequently focus primarily on the patient, their preferences and priorities with regards to oncologic and non-oncologic outcomes and assess their overall health status through a geriatric assessment that includes at minimum comorbidities, medication review, basic and instrument activities of daily living, mobility, falls, nutritional status, cognition, mood and social support. Reporting back to the cancer specialist should be concise, objective whenever possible and to the point. Within the multidisciplinary team, the geriatrician can contribute with information on health status and reserves, remaining life-expectancy and toxicity risks, and by creating awareness of the limitations of evidence regarding the older population. This will help in reaching a well-tailored treatment decision that balances cancer-related and patient-centred outcome measures and fits within the patient's own preferences for treatment.
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