Background: The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential. Methods: This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment. Results: Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3–5 adverse effects of chemotherapy in particular and improve quality of life. Conclusions: Co-management between geriatricians and other specialties should be encouraged wherever possible.
背景：老年患者癌症发病率较高，2018年全球80岁以上患者达230万例。由于该人群的特殊性使治疗选择面临挑战，老年医学专家与其他癌症专科医生的协同管理已逐渐成为必要手段。方法：本叙述性综述旨在整合当前关于老年综合评估在非结直肠消化道癌症老年患者管理中作用的数据。肿瘤老年评估涵盖多维度领域，包括共病状况、自理能力、营养状态、认知功能、情绪状态及功能评估。结果：肿瘤老年学参数对死亡率和不良事件具有预测价值。在非结直肠消化道癌症围手术期管理中，老年医学管理可辅助决策制定、识别衰弱状态，并安排包含营养管理、适应性体能活动和心理护理的三联个体化术前康复方案。其目标在于降低谵妄风险及共病失代偿（以心肺功能为主）发生率——这在老年胆胰手术中并发症率最高，同时尽可能促进原有自理能力恢复，缩短住院时间。对于转移性癌症，或在多模式治疗期间（如局部进展期胃癌的围手术期化疗、食管癌或直肠癌的新辅助放化疗），需特别评估化疗耐受性。神经毒性及化疗脑对老年患者影响更为显著，将加剧自理能力丧失。联合老年医学管理可显著降低3-5级化疗不良反应发生率，并提升生活质量。结论：应尽可能推广老年医学专家与其他专科的协同管理模式。
肿瘤(癌症)患者之家