Radiotherapy and Systemic Anti-Cancer Treatment in Older Adults with Cancer and Frailty

The use of radiation therapy and systemic anticancer therapies in early and late-stage disease requires some additional safety consideration for older cancer patients with frailty. Potential treatment benefits and toxicities and their impact on quality of life, patient-reported outcomes and functional status should be considered in the context of patient preferences, estimated life expectancy, age-related organ function decline and competing risks of death and morbidity. The ageing process correlates with a gradual decline in the function of multiple organs which may reduce reserve capacity and affect toxicity. Radiation therapy is a localised treatment, with potential effects thereby limited to the site of exposure, while systemic therapies present other challenges. Clinical trials are the key to developing more efficient tailored approaches. Efforts should continue to develop dedicated clinical trials as older cancer patients, particularly with frailty, are still largely excluded from participation, thus limiting the evidence base in this patient population. The focus of this chapter is on the role and safety of radiation therapy and systemic therapies in the context of older patients with frailty, with a general overview of toxicities. It also covers general considerations for radiation therapy, factors impacting treatment toxicity, modern radiation therapy techniques and their role in patients with frailty. Systemic therapy is explored regarding its utility for this subgroup of high-risk patients, including the role of chemotherapy, targeted therapies and immunotherapy.