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Improving outcomes for older women with gynaecological malignancies

  • Lucy Dumas
    Affiliations
    Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom
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  • Alistair Ring
    Affiliations
    Breast Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, United Kingdom
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  • John Butler
    Affiliations
    Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom
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  • Tania Kalsi
    Affiliations
    Department of Ageing and Health, 9th Floor North Wing, St Thomas’ Hospital, Guys & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom

    Division of Health and Social Care Research, King’s College London, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom
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  • Danielle Harari
    Affiliations
    Department of Ageing and Health, 9th Floor North Wing, St Thomas’ Hospital, Guys & St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom

    Division of Health and Social Care Research, King’s College London, Capital House, 42 Weston Street, London SE1 3QD, United Kingdom
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  • Susana Banerjee
    Correspondence
    Corresponding author at: Royal Marsden Hospital, 203 Fulham Road, SW3 6JJ London, United Kingdom. Fax: +44 207 811 8103.
    Affiliations
    Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom
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Published:August 29, 2016DOI:https://doi.org/10.1016/j.ctrv.2016.08.007

      Highlights

      • Survival from gynaecological cancers is generally worse for women over the age of 65.
      • Geriatric assessment can identify functional deficits that may predict toxicities and outcomes.
      • Trials focusing on older patients incorporating geriatric assessment and biomarkers are needed.

      Abstract

      The incidence of most gynaecological malignancies rises significantly with increasing age. With an ageing population, the proportion of women over the age of 65 with cancer is expected to rise substantially over the next decade. Unfortunately, survival outcomes are much poorer in older patients and evidence suggests that older women with gynaecological cancers are less likely to receive current standard of care treatment options. Despite this, older women are under-represented in practice changing clinical studies. The evidence for efficacy and tolerability is therefore extrapolated from a younger; often more fit population and applied to in every day clinical practice to older patients with co-morbidities. There has been significant progress in the development of geriatric assessment in oncology to predict treatment outcomes and tolerability however there is still no clear evidence that undertaking a geriatric assessment improves patient outcomes. Clinical trials focusing on treating older patients are urgently required. In this review, we discuss the evidence for treatment of gynaecological cancers as well as methods of assessing older patients for therapy. Potential biomarkers of ageing are also summarised.

      Keywords

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