Multidisciplinary management of liver, pancreatic, and gastric malignancies in older adults

Liver, pancreatic, and gastric cancers are aggressive and common malignancies and their incidence is increased in the elderly. Treatment requires a multidisciplinary approach involving multiple specialties including gastroenterology, surgery, radiation oncology, interventional radiology, and medical oncology. Appropriate management is limited by inherent biases among clinicians and the fact that very fewclinical trials enroll elderly patients. It is well documented across multiple malignancies that elderly patients often receive substandard care, are denied potentially curative surgery, and are less likely to be treated with standard of care chemoand radiation-therapies. However, it is clear that chronological age should not be used as the sole determinant when formulating a treatment strategy. Various tools included within a Comprehensive Geriatric Assessment are available and can aid in the decision-making process, when considering the best treatment for patients with advanced age. Mounting data support the argument that elderly patients derive somewhat similar benefit from treatment compared with younger patients. Surgical complications and toxicities with chemotherapy may be higher in elderly population because of associated comorbidities, diminished functional status, and altered pharmacokinetic profiles. Increased clinical trial accrual of elderly patients is needed and can help provide data to guide management of these complex patients. In the following chapter, we evaluate the multidisciplinary management of liver, pancreatic, and gastric cancer in the elderly with a focus on evidence-based, patientcentered treatment strategies.