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Supportive Care in Elderly Cancer Patients

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The MASCC Textbook of Cancer Supportive Care and Survivorship

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Abstract

It is widely accepted that after the age of 70 comorbidities become more frequent and organ function decreases. Supportive care in the elderly patient is based on the same principles as for younger patients, but elderly patients are at an increased risk of toxicity from any drug due to age-related decrease in organ function, use of polypharmacy with increased risk of drug–drug interactions, and due to comorbidity. The comprehensive geriatric assessment is a multidisciplinary evaluation of the older patient encompassing a number of essential clinical domains, which provides an important method to evaluate a patient who is to undergo a major medical procedure. The specificities of depression in elderly cancer patients remain a largely unexplored field of research. Not all tools for the assessment of pain are equally reliable in the elderly. Analgesics should be used with care in the elderly who are more susceptible to drug side effects. Guidelines on the use of granulocyte colony-stimulating factors recognize older individuals above the age of 65 as a group at high risk. Malnutrition is observed frequently and leads to low albumin levels, a determinant of toxicity for drug therapy. Compliance needs to be carefully evaluated, particularly in patients with high risk of noncompliance such as elderly with dementia and impaired vision. Osteopenia and osteoporosis are frequent in the elderly, both in females and males. Besides exercise and use of calcium and vitamin D, bisphosphonates or denosumab are recommended for some patients.

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References

  1. Pallis AG, Fortpied C, Wedding U, et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer. 2010; 46:1502–1513.

    Article  PubMed  CAS  Google Scholar 

  2. Dixon DO, Neilan B, Jones S, et al. Effect of age on therapeutic outcome in advanced diffuse histocytic lymphoma: the Southwest Oncology Group experience. J Clin Oncol. 1986; 4:295–305.

    PubMed  CAS  Google Scholar 

  3. Extermann M, Aapro M, Bernabei R, et al. Task Force on CGA of the International Society of Geriatric Oncology. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005; 55:241–252.

    Article  PubMed  Google Scholar 

  4. Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002; 20:494–502.

    Article  PubMed  Google Scholar 

  5. PACE participants, Audisio RA, Pope D, Ramesh HS, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008; 65:156–163.

    Google Scholar 

  6. Spoletini I, Gianni W, Repetto L, et al. Depression and cancer: an unexplored and unresolved emergent issue in elderly patients. Crit Rev Oncol Hematol. 2008; 65:143–155.

    Article  PubMed  Google Scholar 

  7. Fisch M. Treatment of depression in cancer. J Natl Cancer Inst Monogr. 2004; 32:105–111.

    Article  PubMed  Google Scholar 

  8. Williams S, Dale J. The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer. 2006; 94:372–390.

    Article  PubMed  CAS  Google Scholar 

  9. Henry NL, Stearns V, Flockhart DA, et al. Drug interactions and pharmacogenomics in the treatment of breast cancer and depression. Am J Psychiatry. 2008; 165:1251–1255.

    Article  PubMed  Google Scholar 

  10. Herr K, Garand L. Assessment and measurement of pain in older patients. Clin Geriatr Med. 2001; 17:457–478.

    Article  PubMed  CAS  Google Scholar 

  11. Urban D, Cherny N, Catane R. The management of cancer pain in the elderly. Crit Rev Oncol Hematol. 2010; 73:176–183.

    Article  PubMed  Google Scholar 

  12. Aapro MS, Cameron DA, Pettengell R, et al. EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the ­incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumors. Eur J Cancer. 2006; 42:2433–2453.

    Article  PubMed  CAS  Google Scholar 

  13. Repetto L, Biganzoli L, Koehne CH, et al. EORTC Cancer in the Elderly Task Force guidelines for the use of colony-stimulating ­factors in elderly patients with cancer. Eur J Cancer. 2003; 39:2264–2272.

    Article  PubMed  CAS  Google Scholar 

  14. Aapro M, Crawford J, Kamioner D. Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now? Support Care Cancer. 2010; 18:529–541. doi: 10.1007/s00520-010-0816-y.

    Article  PubMed  Google Scholar 

  15. Blanc-Bisson C, Fonck M, Rainfray M, Soubeyran P, Bourdel-Marchasson I. Undernutrition in elderly patients with cancer: target for diagnosis and intervention. Crit Rev Oncol Hematol. 2008; 67:243–254.

    Article  PubMed  Google Scholar 

  16. Vellas B, Lauque S, Andrieu S, et al. Nutritional assessment of the elderly. Curr Opin Clin Nutr Metabolic Care. 2001; 4(1):5–8.

    Article  CAS  Google Scholar 

  17. John V, Mashru S, Lichtman S. Pharmacological factors influencing anticancer drug selection in the elderly. Drugs Aging. 2003; 20(10):737–759.

    Article  PubMed  CAS  Google Scholar 

  18. Pond GR, Siu LL, Moore M, et al. Nomograms to predict serious adverse events in phase II clinical trials of molecularly targeted agents. J Clin Oncol. 2008; 26:1324–1330.

    Article  PubMed  Google Scholar 

  19. Jakobsen JN, Herrstedt J. Prevention of chemotherapy-induced nausea and vomiting in elderly cancer patients. Crit Rev Oncol Hematol. 2009; 71:214–221.

    Article  PubMed  Google Scholar 

  20. Hadji P, Body JJ, Aapro MS, et al. Practical guidance for the management of aromatase inhibitor-associated bone loss. Ann Oncol. 2008; 19:1407–1416.

    Article  PubMed  CAS  Google Scholar 

  21. Aapro M, Abrahamsson PA, Body JJ, et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol. 2008; 19:420–432.

    Article  PubMed  CAS  Google Scholar 

  22. Body JJ, Coleman R, Clezardin P, et al. International society of geriatric oncology (SIOG) clinical practice recommendations for the use of bisphosphonates in elderly patients. Eur J Cancer. 2007; 43:852–858.

    Article  PubMed  CAS  Google Scholar 

  23. Cummings SR, San Martin J, McClung MR, et al. FREEDOM Trial. Denosumab for prevention of fractures in postmeno­pausal women with osteoporosis. N Engl J Med. 2009; 361:756–765.

    Article  PubMed  CAS  Google Scholar 

  24. Smith MR, Egerdie B, Hernández Toriz N, et al. Denosumab HALT Prostate Cancer Study Group. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. 2009; 361:745–755.

    Google Scholar 

  25. Santini D, Fratto ME, Galluzzo S, et al. Are bisphosphonates the suitable anticancer drugs for the elderly? Crit Rev Oncol Hematol. 2009; 69:83–94.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinique de Genolier, Multidisciplinary Oncology Institute, 1 route du Muids, 1272, Genolier, Switzerland

    Matti S. Aapro

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  1. Matti S. Aapro
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Correspondence to Matti S. Aapro .

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Editors and Affiliations

  1. Clinical Professor, Cancer Coucil Australia, University of Sydney Medical School, Surry Hills, 2010, New South Wales, Australia

    Ian N. Olver

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© 2010 Society for Imaging Informatics in Medicine

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Aapro, M.S. (2010). Supportive Care in Elderly Cancer Patients. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1225-1_5

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  • DOI: https://doi.org/10.1007/978-1-4419-1225-1_5

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  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-1224-4

  • Online ISBN: 978-1-4419-1225-1

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