TY - JOUR
T1 - Comorbidity and frailty assessment in renal cell carcinoma patients
AU - Courcier, Jean
AU - De La Taille, Alexandre
AU - Lassau, Nathalie
AU - Ingels, Alexandre
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Purpose: Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment. Methods: Narrative, non-systematic review based on PubMed and EMBASE search with the terms “renal neoplasm”, “elderly, frail”, “comorbidities”, “active surveillance”, “metastatic”. The selection was restricted to articles written in English. Results: Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson’s scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients’ risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty. Conclusions: Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
AB - Purpose: Renal cell carcinoma (RCC) incidence has considerably increased during the last decades without any real impact on age-standardized mortality. It questions the relevance of aggressive treatments carrying potential side effects. Conservative management should be considered for frail patients. Comorbidity and frailty assessment in RCC patients is paramount before engaging a treatment. Methods: Narrative, non-systematic review based on PubMed and EMBASE search with the terms “renal neoplasm”, “elderly, frail”, “comorbidities”, “active surveillance”, “metastatic”. The selection was restricted to articles written in English. Results: Comorbidity and frailty assessment go along with the cancer-specific aggressivity and intervention risks assessment. In localized disease, several standardized algorithms offer patient health evaluation to define how suitable the patient would be for curative treatment. The pre-operative American Society of Anesthesiologists and the age-adjusted Charlson’s scores are the most widely used. At the metastatic stage, drug combinations based on immunotherapies and targeted therapies improved cancer outcomes at the price of significant toxicities. Frail patients are not always suitable for such strategies. Commonly used scores like the International Metastatic RCC Database Consortium or Memorial Sloan Kettering Cancer Center integrate features to define patients’ risk groups, more specifically the Karnofsky Performance Score is an easy way to document the frailty. Conclusions: Comorbidity and frailty have to be assessed at any stage of the RCC disease based on a standardized scoring system to define the most suitable treatment strategy ranging from surveillance to aggressive treatment.
KW - Active surveillance
KW - Adverse events
KW - Comorbidity
KW - Frailty
KW - Renal cell carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85101240935&partnerID=8YFLogxK
U2 - 10.1007/s00345-021-03632-6
DO - 10.1007/s00345-021-03632-6
M3 - Article
C2 - 33616708
AN - SCOPUS:85101240935
SN - 0724-4983
VL - 39
SP - 2831
EP - 2841
JO - World Journal of Urology
JF - World Journal of Urology
IS - 8
ER -