Cancer

Question 1

The incidence of CA increases with age up to ____ at which point it levels off.

What is the single biggest risk factor in the development of cancer?

60% of all CAs occur in those age 65 or older, T/F?

70% of all cancer deaths occur in those age 65 or older, T/F?

Answer 1

75 years old

Aging is the biggest risk factor

True

True

Question 2

The biological behavior of the cancer changes with aging. What are some ways this occurs?

Answer 2

Blunted T cell activity and decreased NK cell activity

CA growth factors differ with age

• IL-6 increases with age
• Angiogenesis is altered
• chronic inflammation may promote tumor growth

Question 3

What are some cancers that have a more indolent course in the elderly? (3)

More aggressive? (3)

Most common Cancers overall (4)

Answer 3

Indolent

• some non-small cell lung adenocarcinomas
• estrogen/progesterone responsive positive breast CA
• Prostate CA

Aggressive

• AML
• Large cell non-hodgkin lymphoma
• celomic ovarian cancer

Most common

• breast
• prostate
• lung/bronchus (This is the most common CA in geriatric pts ages 55-74)
• colon and rectum

Question 4

Why are cancer death rates so high in elderly patients?

Answer 4

• organ vulnerability
• co-existing illnesses
• more aggressive tumors
• more likely to have advanced disease at presentation
• age bias: under treatment, reduced participation in CA screening programs, under-representation in clinical trails, health care access issues

Question 5

Treatment of CA

• surgery: what are the risk factors for the elderly
• radiation: what are the risks for the elderly
• chemo: downfalls to this tx in the elderly

Answer 5

Surgical risk factors for elderly

• emergency surgery or prolonged surgery
• co-existing disease (especially CVD, COPD, DM)
• poor nutritional status (wound healing, infections)
• poor functional status

Radiation

• overall very safe and convenient
• major risks: mucositis (dehydration, malnourishment, sepsis) and radiation pneumonitis

Chemo

• more SE than surgery or RT
• increased susceptibility to toxicity
• dose adjustments for reduced GFR or anemia leads to decreased treatment effectiveness
• major risks: myelosuppression (anemia, neutropenia, thrombocytopenia), mucositis (dehydration, malnutrition, sepsis), drug specific toxicities

Question 6

What is Ca tx based on?

Answer 6

The TUMOR CHARACTERISTICS, not the age of the patient

*include risk of tc vs benefit and effects on quality vs quantity of life

Question 7

What is physiologic age?

Answer 7

good estimate of quality of life, life expectancy, and ability to tolerate CA tx

components include: co-morbidities, functional status (ADLs, IALDs), nutritional status, geriatric syndromes (dementia, delirium, depression, falls, spontaneous fx, neglect, abuse, incontinence, nutritional problems)

Question 8

How do we treat CA if the elderly pt is frail?

Answer 8

If frail, palliative tx

If not, llife prolonging tx

intermediate, individualize tx

*treatment is not always warranted

Question 9

Cancer in the elderly

-supportive care examples (things to treat their SE)

Answer 9

• nutritional support: dietary counseling/supplements, G/J tube
• anemia: epoetin alpha
• Neutropenia: epogen or leukine
• Thrombocytopenia: platelet infusion
• Mucositis: supportive care, hydration, magic mouth wash
• N/V: serotonin receptor antagonists (ondansetron)
• Pain: often undertreated in the elderly*
• -pt reluctance to report pain
• -atypical presentation
• -providers fear older pts wont tolerate opiates
• -communication problems