Why the study?
Experts aimed to address real-world challenges in managing an older patient with endometrial cancer, multiple co-morbidities, and polypharmacy, balancing condition optimization against risks of delaying anti-cancer therapy.
In older patients with advanced cancer and polypharmacy, a multidisciplinary approach is essential to balance the time required for physical prehabilitation against the risk of cancer progression, while actively managing dangerous drug-drug interactions.
Supports individualized geriatric prehabilitation in frail endometrial cancer patients; leaves open optimal timing pending prospective validation.
The AsiaPacific Geriatric Oncology Society (AGOS) conducts a monthly virtual tumour board. One of the cases discussed was a 70-year-old female with Stage IIIA endometrial cancer, multiple co-morbidities and polypharmacy. A group of experts discussed the challenges in the real world with specific reference to improving Timed Up and Go (TUG) score, managing the effect of co-morbidities, preventing risk due to drug-drug interactions and evaluating the risk of delaying anti-cancer therapy in an attempt to improve patients’ condition. He real world expert consensus is outlined here. It would take about 12 weeks to improve TUG by 3-5 seconds. Atrial fibrillation (AF), diabetes mellitus type 2, hypertension, and chronic gastritis/GERD stood out as the most important comorbidities that would increase the risk by 1.5 to 3 times for the patient. Important alternative drugs should be used in place of Amiodarone, Metformin combinations and Denosumab to reduce potential drug-drug interactions. There would be a 5 to 15 % risk of cancer progression while trying to improve the TUG score. This could translate into a 15 to 25% relative reduction in overall survival. Best-case, worst-case visuals can be used while counselling patients.
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Parikh et al. (2026) conducted a review in Endometrial cancer (n=1). Delaying anti-cancer therapy for physical rehabilitation and medication optimization vs. Immediate anti-cancer therapy was evaluated on Risk of detectable cancer progression during delay. Delaying anti-cancer therapy by 12 weeks to improve physical function and optimize medications in a frail older patient with Stage IIIA endometrial cancer carries a 5-15% risk of detectable cancer progression.
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