Hepatocellular carcinoma (HCC) remains the second most common cause of death by cancer globally. Delayed development of HCC in hepatitis C carriers and nonalcoholic fatty liver disease has increased the incidence of HCC in the elderly and thus is a concerning global health issue.

Elderly patients with HCC demands an early assessment with a proper oncologic approach, like, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. 

Evidence suggests the use of standard therapeutic options according to HCC stage, liver function, and general clinical conditions in elderly patients because the expected efficacy relies on HCC stage rather than the actual age of the patient. 

Tolerability and efficacy of these treatments are found to be similar between older and younger patients, despite having some specific complications being more frequent in the elderly population, like delirium, increased length of hospital stay, frequent discharge to a rehabilitation institution, cardiopulmonary complications.

Thus the same treatment options should be given to the selected fit elderly patients following proper oncogeriatric assessment as the younger patients. Patients rendered unfit, after the same evaluation, should receive the treatment compatible with the frailty of the patient. They should be managed through a multidisciplinary team including oncological and geriatrician professionals. This will help provide and coordinate an integrated plan for treatment, rehabilitation, support, and long-term care in such patients.

Source: J Hepatocell Carcinoma. 2016 Jun 17;3:9-18. doi: 10.2147/JHC.S101448. PMID: 27574587; PMCID: PMC4994800.