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The following is a summary of “Frailty and Renal Cell Carcinoma: Integration of Comprehensive Geriatric Assessment into Shared Decision-making,” published in the September 2024 issue of Urology by Pecoraro et al.
Frailty, defined as a geriatric syndrome marked by diminished resilience and physiological reserve, significantly influences the prognosis and management strategies for older adults, particularly within the domains of surgical and oncological care. This review aims to elucidate the role of frailty assessment in managing older patients diagnosed with renal masses or renal cell carcinoma (RCC), emphasizing its impact on diagnostic evaluations, treatment modalities, and clinical outcomes. To achieve this, researchers conducted a comprehensive narrative review of the literature, focusing on various definitions of frailty, assessment tools, and their application in geriatric oncology specific to RCC. The study group summarized relevant studies that addressed the prognostic implications of frailty, its influence on treatment results, and potential interventions to mitigate its effects.
Their findings underscore that frailty is a significant negative prognostic factor and can substantially inform decision-making processes in localized and metastatic RCC management. Screening instruments, including the Geriatric Screening Tool 8 (G8) and the Mini-Cognitive Assessment (Mini-COG), are invaluable for clinicians to identify older patients (≥65 years) who would benefit from a more comprehensive geriatric assessment (CGA) conducted by trained geriatric specialists. The CGA facilitates risk stratification and provides critical insights that guide subsequent therapeutic pathways tailored to the patient’s needs. In light of these insights, the investigators advocate for the active participation of geriatricians in multidisciplinary tumor boards as a fundamental priority to address the intricate requirements of frail patients and optimize their clinical outcomes.
Furthermore, they propose the establishment of a dedicated care pathway as a pivotal initial step toward integrating frailty assessments into clinical practice and research concerning RCC. In conclusion, frailty has emerged as a vital consideration that influences the management strategies and outcomes for older patients with RCC. Incorporating geriatricians into diagnostic and therapeutic frameworks offers a pragmatic approach to screening and evaluating frailty, ultimately fostering individualized treatment decisions that align with holistic patient risk profiles. This approach is essential for improving patient care and enhancing the overall quality of life for older adults facing renal malignancies.
Source: sciencedirect.com/science/article/pii/S2588931124002104
