title: Glioblastoma in the elderly - How do we choose who to treat?
abstract: Glioblastoma (GBM) is the commonest primary malignant brain tumour amongst the adult population. Incidence peaks in the 7th and 8th decades of life and as our global population ages, rates are increasing. GBM is an almost universally fatal disease with life expectancy in the range of 3-5months amongst the elderly.
  
  
  
  The assessment of elderly GBM patients prior to treatment decisions is poorly researched and unstandardised. In order to begin tackling this issue we performed a cross-sectional survey across all UK based consultant neuro-oncologists to review their current practice in assessing elderly GBM patients.
  
  
  
  There were 56 respondents from a total of 93 recipients (60% response rate). All respondents confirmed that at least some patients aged 70 or over were referred to their clinics from the local multidisciplinary team meeting (MDT). Only 18% of consultants routinely performed a cognitive or frailty screening test at initial consultation. Of those who performed a screening test, the majority reported that the results of the test changed their treatment decision in approximately 50% of cases. Participants ranked performance status as the most important factor in determining treatment decisions.
  
  
  
  Considering the heterogeneity of this patient population, we argue that performance status is a crude measure of vulnerability within this cohort. Elderly GBM patients represent a unique clinical scenario because of the complexity of distinguishing neuro-oncology related symptoms from general frailty. There is a need for specific geriatric assessment models tailored to the elderly neuro-oncology population in order to facilitate treatment decisions.
authors.affiliation: Sussex Cancer Centre, Brighton BN2 5BE, UK. Electronic address: Cressida.lorimer@bsuh.nhs.uk.
authors.forename: Cressida F
authors.initials: CF
authors.lastname: Lorimer
authors.affiliation: Royal Marsden Hospital, Sutton SM2 5PT, UK. Electronic address: frank.saran@rmh.nhs.uk.
authors.forename: Frank
authors.initials: F
authors.lastname: Saran
authors.affiliation: Institute of Cancer Sciences, University of Glasgow, Glasgow, G12 8QQ, UK. Electronic address: Anthony.chalmers@glasgow.ac.uk.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Chalmers
authors.affiliation: Sussex Cancer Centre, Brighton BN2 5BE, UK. Electronic address: Juliet.brock@bsuh.nhs.uk.
authors.forename: Juliet
authors.initials: J
authors.lastname: Brock
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001932:Brain Neoplasms / Q000628:therapy*; D003072:Cognition Disorders / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D005909:Glioblastoma / Q000628:therapy*; D006801:Humans; D000072141:Neurologists / Q000523:psychology; D000072103:Oncologists / Q000523:psychology; D010348:Patient Care Team / Q000706:statistics & numerical data; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Elderly; Geriatric assessment; Glioblastoma; MGMT; Temozolomide