Operative Surgical Oncology in the Elderly: Epidemiology, Opportunity, Outcome, and Ethical Issues

With the expected rise in the geriatric patient population, delivery of healthcare for elderly patients will require more resources in the next several decades. The development of cancer is more common in the geriatric population since two-thirds of cancers are typically discovered in the elderly. The elderly often have associated medical comorbidities. Treatment of the geriatric patient population will encompass more personalized approaches based on their functional status. Surgical management of elderly cancer patients is complex. Not only does it require incorporation of multimodality care, the treating physician needs to balance risks and benefits from options available due to patient medical comorbidities leading to posttreatment debilitation and side effect profiles. Furthermore, there are also insufficient studies in the elderly population in terms of long-term oncologic follow-up as many studies frequently exclude the elderly in their study designs. With the development of newer modalities of treatment such as ablative procedures, minimally invasive approaches, and immunotherapy, the selection of treatment methods will need to balance optimal oncologic outcome with expected patient survival.