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Geriatric > Cancer > Flashcards

Cancer Flashcards

1
Q

T/F: 60% of all cancers occur in those age 65+ yo.

A

True

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2
Q

Why is aging a factor of cancer incidence?

A
  • Immunosenescence
  • DNA repair mechanism
  • Telomeres shortening (Dec. control of cell proliferation)
  • Inc. resistance to apoptosis
  • Age-related physiologic changes
  • Dec. tissue intergrity
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3
Q

Why is carinogenesis a factor of cancer incidence?

A
  • Immune surveillance
  • Susceptibility to carcinogens
  • Genetic instability (Oncogene Activation; Tumor Suppressor Gene Mutation)
  • Dec. clearance of damaged cells
  • Altered tissue microenvironment
  • Dec. barriers to tumor invasion
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4
Q

Progression of Cancer over time.

A
  1. Initiation - Accumulated genetic alterations
  2. Promotion - Clonal expansion, Premalignant lesion
  3. Malignant Transformation
  4. Progression: Clinical Cancer (Tissue invasion/Metastases)
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5
Q

What can cause the initiation and promotion of cancer to occur?

A
  • Carcinogens
  • Ionizing Radiation
  • Infection
  • Spontaneous Mutations
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6
Q

Why are Cancer Death Rates High in the Elderly?

A
  1. Medical Issues
  2. Age Bias
  3. Healthcare Access Issues
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7
Q

What medical issues can cause cancer death rated to rise?

A
  • Limiting Standard Treatment Options
  • Age-related changes in physiology
  • Co-existing chronic medical conditions
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8
Q

What age biases can cause cancer death rated to rise?

A
  • Under-treatment
  • Reduced participation in cancer screening programs (delayed dx)
  • Under representation in clinical trials (efficacy of treatment)
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9
Q

Age dependent principles in cancer patients.

A
  • Age-related changes in physiology complicated the treatment
  • Cancer occurs in the setting of multiple chronic conditions in older patients
  • Medical decision making styles differ between young and old
  • Preferences for treatment outcomes change with age
  • Physical and cognitive function are major concerns in maintaining independence.
  • Competing risks may obviate treatment
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10
Q

Age-Related Physiologic Changes in the Kidneys

A
  • Age related loss of nephrons
  • Dec GFR about 1 mL/min/year after age 40
  • Tubular and interstitial changes.
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11
Q

What common drugs are effected by the age-related physiologic changes in the kidneys?

A
  • Cisplatin
  • Carboplatin
  • Etoposide
  • Methotrexate
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12
Q

Age-Related Physiologic Changes in the Gastric

A
  • Dec. Acid

- Dec. Digestive Enzymes

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13
Q

What common drugs are effected by the age-related physiologic changes in the gastric?

A
  • Capectiabine
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14
Q

Age-Related Physiologic Changes in the Liver

A
  • Dec. liver volume and blood flow about 1% per year

- Dec. Hepatic Metabolism and clearance of drugs

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15
Q

What common drugs are effected by the age-related physiologic changes in the Liver?

A
  • Polypharmacy

- Comorbidity and Cytochrome System

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16
Q

Age-Related Physiologic Changes in the Immune System

A
  • Dec. bone marrow reserve
  • Macrophages: dec. phagocytic activity, oxidative burst and MHC class II expression
  • NK cells: Dec. cytotoxicity, cytokine/chemokine production, and proliferative response to IL2
  • Inc. serum levels of the IL6, IL-1 Beta, TNF-alpha
17
Q

What do treatment preferences for older patients in cancer depend on?

A
  • Burden of treatment
  • Possible outcomes
  • Likelihood of outcomes

Changes with age and progression of disease

18
Q

T/F: Many older patients would choose against survival for outcomes of physical or cognitive impairment.

A

True

19
Q

T/F: Older persons with multiple morbidities cannot understand concept of competing outcomes and prioritize outcomes to guide decisions

A

False, they can understand the concept.

20
Q

Common Challenges of Effective Cancer Treatment for Older Patients

A
  • Common comorbidities may limit therapeutic options
  • Age-related physiologic changes may impact toxicities
  • Dec. reserve may delay recovery of functional status
  • Prognostic Indices not validated in older patients
  • Optimal tx for elders not known (clinical trial exclusions)
21
Q

Approach Challenges of Effective Cancer Treatment for Older Patients

A
  • Careful medical evaluation of comorbidities and physiologic status
  • Proactive approach to prevent potential complications
  • Early involvement of cancer rehabilitation team
  • Cautious Prognostication
  • Clinical research protocols designed for older patients
22
Q

What are the primary treatment modalities?

A
  • Surgery
  • Chemotherapy (includes hormonal therapy and biological agents)
  • Radiation Therapy
23
Q

What is the best opportunity for cure or control (initial therapy)?

A
  • Surgery or radiation therapy for control of primary tumor, usually with histologic assessment of adjacent/regional lymph nodes
  • Radiotherapy or chemotherapy for spread to adjacent/regional lymph nodes
  • Chemotherapy for systemic (metastatic) disease
  • Focal radiation therapy for symptomatic lesions
24
Q

T/F: Initial chemotherapy cycle often more difficult than later cycles

A

True

25
Q

Ask the patient their goals of treatment.

A
  • Cure
  • Long-term disease control and prolongation of life
  • Palliative/Supportive care (control symptoms, optimize function)
  • Hospice/EOL care (comfort)
26
Q

T/F: Chronological age alone is reliable guide for planning treatment or predicting outcome.

A

False!

  • Effects of aging vary among individual patients
  • Rates of loss of functional reserves vary from organ to organ in any single individual
27
Q

What is important to assess in the treatment planning of a patient? Why?

A
  • Physiologic Age
  • Functional Status
  • A better estimate of QoL, life expectancy, and ability to tolerate cancer treatment
  • Components: Co-morbidity, physio function, and functional status.
28
Q

Surgical Treatment Issues

A
  • Surgery as most effective therapy for local control of many malignancies
  • Most elective surgeries associated with relatively low mortality risk
  • New less invasive procedures with less morbidity (i.e. Laparoscopic procedures; Robotic technology)
  • Surgical risk factors for elderly
29
Q

What are surgical risk factors for the elderly?

A
  • Emergency surgery or prolonged surgery
  • Co-existing disease (especially atherosclerosis, COPD, and diabetes mellitus)
  • Poor nutritional status (wound healing, infections)
  • Poor functional status
30
Q

Radiation Therapy Treatment Issues

A
  • Safe and effective curative and palliative therapy for localized cancer
    • Relatively little functional impairment compared to surgery and chemotherapy
  • Short course RT very safe and convenient (especially for sick patients)
31
Q

Chemotherapy Treatment Issues

A
  • Increased susceptibility to drug toxicity
  • Dec. functional reserves
  • Co-existing dz
  • Altered metabolism and distribution of drugs
  • Decreased treatment effectiveness due to dose reductions related to drug toxicities
32
Q

What are common drug toxicities?

A
  • Neutopenia and sepsis
  • Thrombocytopenia and bleeding
  • Anemia → fatigue, cardiopulmonary decompensation
  • Vomiting/diarrhea → dehydration, anorexia and malnutrition
  • Renal impairment
  • Neurotoxicity
  • Cardiotoxicity
33
Q

________ is a predictor of poor outcomes. Such as:

A

Frailty:

  • Morbidity (inc. falls, ADL, disability, hospitalizations)
  • Mortality (5-year mortality)
  • Surgical Outcomes (independent predictor of post-op complications, LOS, and discharge to skilled nursing or assisted living facilities)
  • Chemotherapy (Inc. probablity of not completing treatment, inc. mortality with chemotherapy)
34
Q

Frailty Index

A
  • Age 85+
  • ADL Dependence > 1
  • Co-morbid conditions 3+
  • Geriatric syndromes > 1
  • Unintentional Weight loss
  • Significant Muscular Weakness and Fatigue
35
Q

“Fried” Frailty Index

A
  • Unintentional Weight Loss
  • Slow walking Speed
  • Subjective exhaustion
  • Low grip strength
  • Low levels of physical activity
36
Q

If the patient is frail, what should we consider for treatment?

A

Palliative Care

37
Q

Supportive Care Program

A
  • Nutritional Support
  • Medical Support
  • Psychosocial Support
  • Physical/Occupational Therapy

Geriatric (9 decks)

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