Perioperative Care of the Elderly Cancer Patient

Age is the single most important risk factor for cancer. The demographic of age above 60 is the largest growing segment of our patient population in the USA. Solid tumors are common in this age group, and surgery remains the mainstay of treatment. General health of the elderly patients is a complex interplay of biologic age, physiologic reserve, and functional status. While chronologic age is an independent predictor of worse short-term outcomes after oncologic surgery, this effect is comparable to the other preoperative risk factors. Elderly patients with good functional capacity generally do well with surgery but are more susceptible to complications than younger patients due to poor functional reserve. As a result, elderly patients suffer greater morbidity, increased length of stay, and mortality from postoperative complications. It is important to have a thorough understanding of ways to optimize care within the perioperative arena by focusing on functional assessments and interventions available to the entire medical team caring for the surgical patient. Appropriate advanced care planning, establishing the symptom burden and discussing the patient’s desires as well as a thorough discussion of treatment options will guide the physician in determining the best plan of care for the patient. In addition, appreciation for frailty, previous neoadjuvant chemotherapy or radiation therapy, as well as intraoperative techniques available to minimize morbidity are all crucial to care for the elderly patient with cancer. Assessment and understanding each patient’s comorbidities remain essential to appropriately optimize surgical success and minimize symptom burden.