Lee Peter L, Fitch Carla, Efstathiou Jason A, Garg Tullika
Department of Radiation Oncology, Mass General Brigham, Boston, MA.
Departments of Urology and Population Health Sciences, Geisinger Health System, Danville, PA.
Am Soc Clin Oncol Educ Book. 2026 Feb;46(2):e516010. doi: 10.1200/EDBK-26-516010. Epub 2026 Feb 23.
Frailty captures multiple physical, mental, and social vulnerabilities that affect older adults with cancer and is associated with clinical outcomes. A major challenge in oncology is how best to avoid undertreatment or overtreatment by tailoring cancer care for older adults and optimizing frailty or associated vulnerabilities. A barrier to right-sizing cancer treatment in older adults is the fact that practice guidelines are often based on data from clinical trials that exclude older adults and frail patients. Meanwhile, the incidence of cancer diagnoses in older adults continues to increase, especially in genitourinary (GU) cancers (prostate cancer, bladder cancer, and kidney cancer). As a result, there is increasing interest in oncology to develop treatment models and interventions to optimize care for older patients with cancer. In this article, we define frailty and review its association with clinical outcomes across the three most common GU cancers in older adults (prostate, bladder, and kidney cancer). We discuss existing professional society guidelines, consensus recommendations, and practical strategies to implement frailty screening, oncology-focused geriatric assessments, and targeted interventions to optimize vulnerabilities in GU cancers. We also discuss emerging innovations in geriatric oncology such as digital health tools and artificial intelligence.
衰弱体现了多种身体、心理和社会方面的脆弱性，这些脆弱性会影响老年癌症患者，并与临床结局相关。肿瘤学面临的一个主要挑战是，如何通过为老年人量身定制癌症护理并优化衰弱或相关脆弱性，来最好地避免治疗不足或过度治疗。在为老年人合理确定癌症治疗方案方面存在一个障碍，即实践指南往往基于排除了老年人和体弱患者的临床试验数据。与此同时，老年人癌症诊断的发病率持续上升，尤其是在泌尿生殖系统（GU）癌症（前列腺癌、膀胱癌和肾癌）方面。因此，肿瘤学界越来越有兴趣开发治疗模式和干预措施，以优化老年癌症患者的护理。在本文中，我们定义了衰弱，并回顾了它与老年人三种最常见的GU癌症（前列腺癌、膀胱癌和肾癌）临床结局的关联。我们讨论了现有的专业学会指南、共识建议以及实施衰弱筛查、以肿瘤学为重点的老年评估和针对性干预措施以优化GU癌症脆弱性的实用策略。我们还讨论了老年肿瘤学中的新兴创新，如数字健康工具和人工智能。
