Should you screen nursing home residents for cancer?

When considering screening for early cancer detection physicians should anticipate how they plan to follow up a screen detected cancer. Geriatric oncology research has developed validated functional assessments to estimate the balance of risk and benefit for treating cancers in the elderly. Robust elderly can benefit from treatment and therefore might benefit from screening. However the majority of elderly in long term residential care (LTC, or “the nursing home”) would not benefit from cancer screening. The 1.4 million elderly people who reside in U.S. nursing homes represent the oldest and frailest segment of the aged population. On average, LTC residents have less than 5 years estimated remaining life expectancy (RLE.) E.U. figures are similar. The majority have multiple functional deficits that would result in geriatric oncology screening scores in the frail range, at very high risk for severe toxicity from standard chemotherapy or extensive surgery. Therefore screening for asymptomatic cancer is not likely to benefit and has the potential to harm elderly nursing home residents.