Beyond Chronologic Age: Frailty, Geriatric Assessment, and Personalized Care for Older Adults With Genitourinary Cancer

Frailty captures multiple physical, mental, and social vulnerabilities that affect older adults with cancer and is associated with clinical outcomes. A major challenge in oncology is how best to avoid undertreatment or overtreatment by tailoring cancer care for older adults and optimizing frailty or associated vulnerabilities. A barrier to right-sizing cancer treatment in older adults is the fact that practice guidelines are often based on data from clinical trials that exclude older adults and frail patients. Meanwhile, the incidence of cancer diagnoses in older adults continues to increase, especially in genitourinary (GU) cancers (prostate cancer, bladder cancer, and kidney cancer). As a result, there is increasing interest in oncology to develop treatment models and interventions to optimize care for older patients with cancer. In this article, we define frailty and review its association with clinical outcomes across the three most common GU cancers in older adults (prostate, bladder, and kidney cancer). We discuss existing professional society guidelines, consensus recommendations, and practical strategies to implement frailty screening, oncology-focused geriatric assessments, and targeted interventions to optimize vulnerabilities in GU cancers. We also discuss emerging innovations in geriatric oncology such as digital health tools and artificial intelligence.