Resumo
La prevalencia del cáncer incrementa con el envejecimiento, el 60% de la incidencia y el 70% de las muertes relacionadas con cáncer ocurren en los adultos mayores. Distintas sociedades científicas han realizado recomendaciones sobre el abordaje del paciente anciano con cáncer a través de la valoración geriátrica integral (VGI), donde se valora la situación funcional, presencia de comorbilidades, síndromes geriátricos, estado cognitivo, situación social y estado nutricional en el paciente oncológico previo al inicio y durante el tratamiento oncológico con el objetivo de identificar factores asociados a toxicidad por quimioterapia, radioterapia e inmunoterapia. En esta segunda parte de aproximación a la toxicidad en el adulto mayor desde la perspectiva de la oncogeriatría y los cuidados paliativos, se brindará información puntual para los médicos no oncólogos sobre los distintos modelos de atención en oncogeriatría, la importancia de la valoración geriátrica integral, modelos de predicción de toxicidad, e intervenciones en rehabilitación oncológica y cuidados paliativos en pacientes adultos mayores con cáncer.
Liposits G, Orrevall Y, Kaasa S, Österlund P, Cederholm T. Nutrition in Cancer Care: A Brief, Practical Guide With a Focus on Clinical Practice. JCO Oncol Pract [Internet]. 2021 Jan 14;17(7):e992–8. Available from: https://doi.org/10.1200/OP.20.00704
World Health Organization. (2018). Ageing and health. https:// www.who.int/news-room/fact-sheets/detail/ageing-and-health.
Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clinical Nutrition [Internet]. 2021;40(5):2898–913. Available from: https://doi.org/10.1016/j.clnu.2021.02.005
Kalsi T, Babic-Illman G, Fields P, Hughes S, Maisey N, Ross P, et al. The impact of low-grade toxicity in older people with cancer undergoing chemotherapy. Br J Cancer. 2014 Dec;111(12):2224–8.
Garrido MJM, Ponce CG. Oncogeriatry, a way to optimize the overall care of older patients with diagnosis of cancer. Nutr Hosp. 2016;33(1):31–9.
Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: A prospective multicenter study. Journal of Clinical Oncology. 2011;29(25):3457–65.
Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: An update on SIOG recommendations. Annals of Oncology. 2015;26(2):288–300.
Molina-Garrido MJ, Soriano Rodríguez MC, Guillén-Ponce C. ¿Cuál es el papel de la valoración geriátrica integral en Oncogeriatría? Rev Esp Geriatr Gerontol. 2019;54(1):27–33.
Verduzco-Aguirre HC, Navarrete-Reyes AP, Negrete-Najar JP, Soto-Pérez-De-Celis E. Cáncer en el adulto mayor en Latinoamérica: cooperación interdisciplinaria entre oncología y geriatría. Revista de Salud Pública [Internet]. 2020;22(3):1–9. Available from: http://10.0.60.86/rsap.v22n3.84617
Nieto González MA, Osorio Osorio MA, Coca León DJ, Heredia Ramírez RA, Russi Noguera YA, Pinilla PA, Pinilla Aldana TL, Méndez Rodríguez LM, Molina Reyes SA, Gnecco Patarroyo D. Toxicidad en el adulto mayor desde la perspectiva de oncogeriatría y los cuid.
González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, et al. Geriatría transversal. Un reto asistencial para el siglo xxi. Rev Esp Geriatr Gerontol [Internet]. 2020;55(2):84–97. Available from: https://www.elsevier.es/es-revista-revista-espanola-geriatria-gerontologia-124-articulo-geriatria-transversal-un-reto-asistencial-S0211139X1930201X
Honorato M, Calderón O, Rojas V, Fasce G, Bartolotti C, Caglevic C. Considerations and analysis of the implementation of oncogeriatrics in Chile and its importance: Review of current literature [Internet]. Vol. 4, Frontiers in Aging . 2023. Available from: https://www.frontiersin.org/articles/10.3389/fragi.2023.1141792
Magnuson A, Dale W, Mohile S. Models of Care in Geriatric Oncology. Curr Geriatr Rep. 2014 Sep;3(3):182–9.
Molina-Garrido MJ, Soriano Rodríguez MC, Guillén-Ponce C. ¿Cuál es el papel de la valoración geriátrica integral en Oncogeriatría? Rev Esp Geriatr Gerontol [Internet]. 2019;54(1):27–33. Available from: https://www.elsevier.es/en-revista-revista-espanola-geriatria-gerontologia-124-articulo-cual-es-el-papel-valoracion-S0211139X1830619X
Monfardini S, Perrone F, Balducci L. Pitfalls in Oncogeriatrics. Vol. 15, Cancers. 2023.
Pardo, C., et al. Caracterización de la población adulta mayor con cáncer del Centro Javeriano de Oncología. [Internet]. 2019. [citado: 2023, noviembre] Disponible en: http://hdl.handle.net/10554/47199.
Rodríguez Couso M. Intervenciones geriátricas en el mayor con cáncer basadas en la valoración geriátrica integral. Áreas de optimización: lo que el geriatra puede aportar al equipo multidisciplinar. Nutr Hosp. 2020;
Martínez Peromingo FJ, Oñoro Algar C, Baeza Monedero ME, González de Villaumbrosia C, Real de Asua Cruzat D, Barba Martín R. Propuesta de desarrollo de una unidad de oncogeriatría. Tiempos de cambio: nuestra realidad. Rev Esp Geriatr Gerontol [Internet]. 2018;53(3):149–54. Available from: https://www.elsevier.es/es-revista-revista-espanola-geriatria-gerontologia-124-articulo-propuesta-desarrollo-una-unidad-oncogeriatria--S0211139X17302159
Karnofsky DA, Burchenal JH. In: Evaluation of chemotherapeutic agents. MacLeod CM, editor. New York: Columbia University Press; 1949. The clinical evaluation of chemotherapeutic agents in cancer; pp. 191–205.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982 Dec;5(6):649-55.
Feliu J, Heredia-Soto V, Gironés R, Jiménez-Munarriz B, Saldaña J, Guillén-Ponce C, et al. Can we avoid the toxicity of chemotherapy in elderly cancer patients? Crit Rev Oncol Hematol [Internet]. 2018;131(June):16–23. Available from: https://doi.org/10.1016/j.critrevonc.2018.08.008
Mohile SG, Dale W, Somerfield MR, Schonberg MA, Boyd CM, Burhenn PS, et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology. Journal of Clinical Oncology [Internet]. 2018;36(22):2326–47. Available from: http://10.0.4.176/jco.2018.78.8687
Cruz P, Acevedo F. Escalas de estado funcional (o performance status) en cáncer. Gastroenterol latinoam. 2014;25(3):219–26.
Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, et al. Grip strength across the life course: Normative data from twelve British studies. PLoS One. 2014;9(12):1–15.
Laube R, Wang H, Park L, Heyman JK, Vidot H, Majumdar A, et al. Frailty in advanced liver disease. Vol. 38, Liver International. Blackwell Publishing Ltd; 2018. p. 2117–28.
de Fátima Ribeiro Silva C, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short physical performance battery as a measure of physical performance and mortality predictor in older adults: A comprehensive literature review. Int J Environ Res Public Health. 2021;18(20).
Gascón-Ruiz M, Casas-Deza D, Marti-Pi M, Torres-Ramón I, Zapata-García M, Sesma A, et al. Diagnosis of Malnutrition According to GLIM Criteria Predicts Complications and 6-Month Survival in Cancer Outpatients. Biomedicines. 2022;10(9):1–10.
Liposits G, Orrevall Y, Kaasa S, Österlund P, Cederholm T. Nutrition in Cancer Care: A Brief, Practical Guide With a Focus on Clinical Practice. JCO Oncol Pract. 2021;17(7):e992–8.
Sourdet S, Brechemier D, Steinmeyer Z, Gerard S, Balardy L. Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology. BMC Cancer [Internet]. 2020;20(1). Available from: http://10.0.4.162/s12885-020-06878-2
Festen S, Kok M, Hopstaken JS, van der Wal-Huisman H, van der Leest A, Reyners AKL, et al. How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study. J Geriatr Oncol [Internet]. 2019;10(6):951–9. Available from: https://doi.org/10.1016/j.jgo.2019.04.006
Hamaker ME, Te Molder M, Thielen N, Van Munster BC, Schiphorst AH, Van Huis LH. The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients – A systematic review. J Geriatr Oncol [Internet]. 2018;9(5):430–40. Available from: http://10.0.3.248/j.jgo.2018.03.014
Suto H, Inui Y, Okamura A. Predicting Chemotherapy-Related Adverse Events in Elderly Cancer Patients with Prior Anticancer Therapy. Current Oncology. 2022;29(4):2185–92.
Li D, Sun CL, Kim H, Soto-Perez-De-Celis E, Chung V, Koczywas M, et al. Geriatric Assessment-Driven Intervention (GAIN) on Chemotherapy-Related Toxic Effects in Older Adults with Cancer: A Randomized Clinical Trial. JAMA Oncol. 2021;7(11):1–10.
Kalsi T, Babic-Illman G, Fields P, Hughes S, Maisey N, Ross P, et al. The impact of low-grade toxicity in older people with cancer undergoing chemotherapy. Br J Cancer. 2014;111(12):2224–8.
Kotzerke D, Moritz F, Mantovani L, Hambsch P, Hering K, Kuhnt T, et al. The performance of three oncogeriatric screening tools - G8, optimised G8 and CARG - in predicting chemotherapy-related toxicity in older patients with cancer. A prospective clinical study. J Geriatr Oncol. 2019;10(6):937–43.
Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, et al. Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life. Eur J Cancer Care (Engl). 2014;23(3):401–12.
Bellera, C.A., Rainfray, M., Mathoulin-Pélissier, S., Mertens, C., Delva, F., Fonck, M., Soubeyran, P.L., 2012. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Annals of Oncology 23, 2166–2172.
Soubeyran P, Bellera C, Goyard J, Heitz D, Cure H, Rousselot H, et al. Validation of the G8 screening tool in geriatric oncology: The ONCODAGE project. Journal of Clinical Oncology [Internet]. 2011 May 20;29(15_suppl):9001. Available from: https://doi.org/10.1200/jco.2011.29.15_suppl.9001
Schiefen JK, Madsen LT, Dains JE. Treatment Risk in the Senior Population. 2017;528–33.
Chan WL, Ma T, Cheung KL, Choi H, Wong J, Lam KO, et al. The predictive value of G8 and the Cancer and aging research group chemotherapy toxicity tool in treatment-related toxicity in older Chinese patients with cancer. J Geriatr Oncol [Internet]. 2020;(xxxx):4–9. Available from: https://doi.org/10.1016/j.jgo.2020.10.013
Peterson LL, Hurria A, Feng T, Mohile SG, Owusu C, Klepin HD, et al. HHS Public Access. 2018;8(2):96–101.
Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, Defelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: The chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer. 2012;118(13):3377–86.
Rosselli D. The mini-mental state examination as a diagnostic selection test for dementia: A Colombian population study. Rev Neurol. 2000;30(5):428–32.
Chavarro-Carvajal DA, Heredia Ramírez RA, Venegas Sanabria LC, Caicedo Correa SM, Gómez Arteaga RC, Pardo Amaya AM, et al. Escalas de uso frecuente en Geriatría. 2020. 1–82 p.
Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, Defelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: The chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer. 2012;118(13):3377–86.
Ortland I, Mendel Ott M, Kowar M, Sippel C, Jaehde U, Jacobs AH, et al. Comparing the performance of the CARG and the CRASH score for predicting toxicity in older patients with cancer. J Geriatr Oncol [Internet]. 2020;11(6):997–1005. Available from: https://doi.org/10.1016/j.jgo.2019.12.016
Hayes SC, Davies PS, Parker TW, Bashford J, Green A. Role of a mixed type, moderate intensity exercise programme after peripheral blood stem cell transplantation. Br J Sports Med. 2004 Jun;38(3):304–9; discussion 309.
Tsuji T. the Front Line of Cancer Rehabilitation in Japan: Current Status and Future Issues. J Cancer Rehabil. 2019;2:10–7.
Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med. 2007 Aug;147(3):156–64.
Williams GR, Dunne RF, Giri S, Shachar SS, Caan BJ. Sarcopenia in the Older Adult With Cancer. J Clin Oncol. 2021 Jul;39(19):2068–78.
Dunne RF, Loh KP, Williams GR, Jatoi A, Mustian KM, Mohile SG. Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review. Cancers (Basel). 2019 Nov;11(12).
Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol. 2010 Jan;28(2):340–7.
Adams SC, Segal RJ, McKenzie DC, Vallerand JR, Morielli AR, Mackey JR, et al. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Breast Cancer Res Treat. 2016 Aug;158(3):497–507.
Balducci L, Fossa SD. Rehabilitation of older cancer patients. Acta Oncol. 2013 Feb;52(2):233–8.
Franklin DJ. Cancer rehabilitation: challenges, approaches, and new directions. Phys Med Rehabil Clin N Am. 2007 Nov;18(4):899–924, viii.
Hoppe S, Rainfray M, Fonck M, Hoppenreys L, Blanc JF, Ceccaldi J, et al. Functional decline in older patients with cancer receiving first-line chemotherapy. J Clin Oncol. 2013 Nov;31(31):3877–82.
Silver JK, Gilchrist LS. Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions. Am J Phys Med Rehabil. 2011 May;90(5 Suppl 1):S5-15.
Schmitz KH, Holtzman J, Courneya KS, Mâsse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2005 Jul;14(7):1588–95.
Dietz JH. Rehabilitation Oncology [Internet]. Wiley; 1981. (Wiley medical publication). Available from: https://books.google.com.co/books?id=t3hrAAAAMAAJ
Pergolotti M, Williams GR. Rehabilitation needs of older adults with cancer. In: Stubblefield MD, Michael D, editor. Cancer Rehabilitation: Principles and Practice, 2nd edn. New York: Demos Medical, 2018; 907–16.
Tsuji T. The frontline of cancer rehabilitation in Japan: current status and future issues. JCR 2019;2:10–7.
Frontera, Walter R.; Joel A. DeLisa; Bruce M. Gans; Nicholas E. Walsh; Lawrence R. Robinson; and Jeffrey Basford. “Physical Medicine and Rehabilitation: Principles and Practice.” (2010).
Saotome T, Klein L, Faux S. Cancer rehabilitation: a barometer for survival? Support Care Cancer. 2015 Oct;23(10):3033–41.
Yates P. Symptom Management and Palliative Care for Patients with Cancer. Nursing Clinics of North America [Internet]. 2017;52(1):179–91. Available from: http://dx.doi.org/10.1016/j.cnur.2016.10.006
Brant JM. Palliative Care for Adults Across the Cancer Trajectory: From Diagnosis to End of Life. Semin Oncol Nurs [Internet]. 2010;26(4):222–30. Available from: http://dx.doi.org/10.1016/j.soncn.2010.08.002
Organización Mundial de la Salud. Palliative care. [Internet]. Geneva: World Health Organization; [actualizado en 2021 Sep 8; consultado en 2023 Abril 24]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/palliative-care.
Akgün KM. Palliative and End-of-Life Care for Patients with Malignancy. Clin Chest Med [Internet]. 2017;38(2):363–76. Available from: http://dx.doi.org/10.1016/j.ccm.2016.12.010
Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, et al. American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8):880–7.
Haddad A, Shepard D. Geriatric oncology and palliative medicine. Semin Oncol [Internet]. 2011;38(3):362–6. Available from: http://dx.doi.org/10.1053/j.seminoncol.2011.03.004
Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, et al. Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA - Journal of the American Medical Association. 2016;316(20):2104–14.
Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, et al. Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. Journal of Clinical Oncology. 2015;33(13):1438–45.
Ferrell B, Sun V, Hurria A, Cristea M, Raz DJ, Kim JY, et al. Interdisciplinary Palliative Care for Patients with Lung Cancer. J Pain Symptom Manage [Internet]. 2015;50(6):758–67. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2015.07.005
Haun MW, Estel S, Rücker G, Friederich HC, Villalobos M, Thomas M, et al. Early palliative care for adults with advanced cancer. Cochrane Database of Systematic Reviews. 2017;2017(6).

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Manuel Alejandro Nieto González, Marcela Andrea Osorio Osorio, David José Coca León, Rodrigo Alberto Heredia Ramírez, Juli Andrea Russi Noguera, Gabriela Negrete-Tobar, Karen Lizeth Cuervo Martínez, María Beatriz Valdivieso Márquez, Natalia Manrique Marín, María Baquero Fonseca