Current Perspective Vulnerable and frail elderly: An approach to the management of the main tumour types Silvio Monfardini a, * , Cesare Gridelli b , Lara M. Pasetto a , Pierre Soubeyran c , Jean-Pierre Droz d , Umberto Basso a a Geriatric Oncology Program Department of Medical Oncology, Istituto Oncologico Veneto-IOV-IRCCS, via Gattamelata 64, 35128, Padova, Italy b Division of Medical Oncology, Moscati Hospital, Avellino, Italy c Comprehensive Cancer Center Institut Bergonie ´, Bordeaux, France d Department of Medical Oncology, Centre Le ´on Be ´rard, Lyon, France ARTICLE INFO Article history: Received 19 December 2007 Accepted 4 January 2008 Available online 31 January 2008 Keywords: Cancer in the elderly Frailty Vulnerability Breast cancer Colorectal cancer Prostate cancer Non-Hodgkin’s Lymphoma ABSTRACT In dealing with older cancer patients undergoing chemotherapy, some form of geriatric evaluation is needed to distinguish those which can be treated as adults from those – the vulnerable ones – who need a modified approach and also from those who are frail or too sick to receive an active treatment. Only scarce data are available to guide treatment of vulnerable or frail patients, the neglected majority of older cancer patients. In most of these cases they receive an adapted approach which does not derive from the results of clinical trials, but from an enlightened empiricism. In this article we summarise and dis- cuss available data for management of the main tumour types in frail and vulnerable patients, and call for further research in this field. Ó 2008 Elsevier Ltd. All rights reserved. 1. Introduction While planning a medical therapy for an older cancer patient, we are continually in the position of deciding whether this case should be treated with full dose chemotherapy or with reduced doses or, as a third option, without an active treat- ment if he or she is too sick to receive it. The Performance Status (PS) has been an useful instrument for adult patients to orient the therapeutic decision, but in the elderly, the Mul- tidimensional Geriatric Assessment (MGA) 1–3 adds to the sim- ple PS 4 since it covers the multifaceted features of age- associated conditions. There is no doubt that a complete MGA will provide more information compared to PS on the capability of the old pa- tient, for example, of phoning a physician or a nurse, using public transportation or taking medications. 5 More than the simple PS, assessment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) will give infor- mation on the degree of autonomy of the old patient. The pos- sibility of being taken care of depends also on the mental status and presence or absence of depression, but PS again does not give any information on these parameters. However, a full MGA is seldom carried out even by those Medical Oncologists interested in taking care of older pa- 0959-8049/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2008.01.002 * Corresponding author: Tel.: +39 49 8215931; fax: +39 49 8215932. E-mail address: silvio.monfardini@unipd.it (S. Monfardini). EUROPEAN JOURNAL OF CANCER 44 (2008) 488 – 493 available at www.sciencedirect.com journal homepage: www.ejconline.com