Gastroesophageal Cancer in Older Adults with Frailty

Gastro-oesophageal cancer is an age-related illness; over 50% of patients are diagnosed over the age of 75. Given this age demographic and associations with obesity and smoking patients often live with chronic health conditions and varying degrees of frailty. The multidisciplinary team needs to factor in evidence of frailty when planning patient management. For early cancers endoscopic options may be considered in preference to surgery and for those with more locally advanced disease radiotherapy options may be considered. Age alone should not preclude an optimal approach including both chemotherapy and surgery for appropriately selected and counselled patients with potentially curative disease. Frailty is however a key consideration in this decision-making process. For those older patients with frailty diagnosed with more advanced disease, dose adjusted chemotherapy is recommended but for some patients, supportive care alone may be advisable. This chapter presents a review of the most suitable treatment options for the sub-group of older adults with frailty diagnosed with gastro-oesophageal cancer, from an early stage to a metastatic setting.