Cancer in the Elderly Flashcards
What is the single biggest risk factor in the development of cancer?
Aging
Cancer Biology & Aging
Blunted T-cell & NK cell activity
IL-6 increases
Angiogenesis is altered
Chronic inflammation may promote tumor growth
Cancers with an Indolent Course in the Elderly
Non-small cell lung adenocarcinomas
Estrogen/progesterone responsive positive breast cancers
Prostate cancer
Cancers that are More Aggressive in the Elderly
AML
Large cell non-Hodgkin lymphoma
Celomic ovarian cancer
Most Common Cancer Types in the Elderly
Breast
Prostate
Lung/bronchus
Colon & rectum
Reason Cancer Deaths Rates are so High
Organ vulnerability Co-existing illnesses More aggressive tumors More likely to have advance disease at presentation Age bias
Age Bias in Cancer
“Treatment too dangerous for elderly”
Reduced participation in cancer screening programs
Under-representation in clinical trials
Health care access issues
Treatment Options for Cancer in the Elderly
Surgery
Radiation
Chemotherapy
Surgery for Cancer Treatment
Most effective of many malignancies
Relatively low mortality risk
Surgical Risk Factors for the Elderly
Emergency surgery or prolonged surgery
Co-morbidities
Poor nutritional status
Poor functional status
Radiation for Cancer Treatment
Safe & effective curative & palliative therapy for localized cancers
Short course RT & brachytherapy very safe & convenient
Major Risks of Radiation
Mucositis (dehydration, malnourishment, sepsis)
Radiation pneumonitis
Chemotherapy for Cancer Treatment
More SE than surgery or RT
Increased susceptibility to toxicity
Dose adjustment for reduced GFR or anemia (decreased treatment effectiveness)
Reasons for Increased Susceptibility to Toxicity
Decreased functional reserves
Co-existing disease
Altered metabolism & distribution of drugs
Poor stem cell recovery
Major Risks for Chemotherapy
Myelosuppression
Mucositis
Drug specific toxicities
Myelosuppression as a SE of Chemotherapy
Anemia: reduced O2 carying capacity
Neutropenia: sepsis
Thrombocytopenai: bleeding
Mucositis as a SE of Chemotherapy
Dehydration
Malnutrition
Sepsis
Drug Specific Toxicities as a SE of Chemotherapy
Renal insufficiency: platinum
Cardiotoxicity: anthracyclines
Neurotoxicity: platinum, taxanes, vincristine
Cancer Treatment Decisions in Older Adults
Should be based on tumor characteristics
Patient’s functional status
Risk vs. benefit & effects of quality vs. quantity of life
Patients treatment goals
Avoid under treatment of curable disease
Avoid over treatment of indolent cancers or cancers with poor prognosis
Physiologic Age
Good estimate of quality of life, life expectancy, & ability to tolerate cancer treatment
Components of Physiologic Age
Co-morbidities
Functional status
Nutritional status
Geriatric syndromes
Co-Morbidities of Interest
CVD Respiratory disease Thromboembolic disease DM Renal insufficiency Neurologic disease Anemia
Define Functional Status
Self care & the ability to maintain an independent life
How to measure functional status in the elderly?
ADLs
IADLs
Examples of ADLs
Bathing Dressing Eating Toileting Continence Transferring
Examples of IADLs
Use of transport Shopping Ability to take medications Provide one's own meals Manage finances Do laundry & housekeeping
Cancer Treatment Planning & Nutritional Status
Protein/calorie malnutrition Weight loss: >10 pounds over 6 months Loss of muscle mass BMI less than 20 Serum albumin: less than 3.2 g/dL
Cancer Treatment Planning & Geriatric Syndromes
Dementia Delirium Depression Falls Spontaneous fractures Neglect & abuse Incontinence Nutritional problems
Cancer Treatment Planning & Frailty
Yes: palliative
No: life prolonging treatment
Intermediate: individualize
Supportive Care for the Elderly with Cancer Treatment
Nutritional support Anemia-epoitin alpha Epogen or Leukine Thrombocytopenia-platelet transfusion Mucositis-supportive care N/V serotonin receptor antagonists (ondansetron) Pain control
Nutritional Support for Cancer Treatment
Dietary counseling
Dietary supplements
Enteral feeding (G/J tube)
Mucositis-Supportive Care for Cancer Treatment
Hydration
“Magic mouth wash”
Diet modification
Anti-diarrheals
Atypical Presentation of Pain
Confusion
Fatigue
Withdrawal
Depression
Communication Problems
Cognitive impairment
Language
Cultural factors
