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Geriatrics > Cancer in the Elderly > Flashcards

Cancer in the Elderly Flashcards

1
Q

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

A

Aging

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2
Q

Cancer Biology & Aging

A

Blunted T-cell & NK cell activity
IL-6 increases
Angiogenesis is altered
Chronic inflammation may promote tumor growth

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3
Q

Cancers with an Indolent Course in the Elderly

A

Non-small cell lung adenocarcinomas
Estrogen/progesterone responsive positive breast cancers
Prostate cancer

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4
Q

Cancers that are More Aggressive in the Elderly

A

AML
Large cell non-Hodgkin lymphoma
Celomic ovarian cancer

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5
Q

Most Common Cancer Types in the Elderly

A

Breast
Prostate
Lung/bronchus
Colon & rectum

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6
Q

Reason Cancer Deaths Rates are so High

A 
Organ vulnerability
Co-existing illnesses
More aggressive tumors
More likely to have advance disease at presentation
Age bias
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7
Q

Age Bias in Cancer

A

“Treatment too dangerous for elderly”
Reduced participation in cancer screening programs
Under-representation in clinical trials
Health care access issues

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8
Q

Treatment Options for Cancer in the Elderly

A

Surgery
Radiation
Chemotherapy

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9
Q

Surgery for Cancer Treatment

A

Most effective of many malignancies

Relatively low mortality risk

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10
Q

Surgical Risk Factors for the Elderly

A

Emergency surgery or prolonged surgery
Co-morbidities
Poor nutritional status
Poor functional status

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11
Q

Radiation for Cancer Treatment

A

Safe & effective curative & palliative therapy for localized cancers
Short course RT & brachytherapy very safe & convenient

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12
Q

Major Risks of Radiation

A

Mucositis (dehydration, malnourishment, sepsis)

Radiation pneumonitis

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13
Q

Chemotherapy for Cancer Treatment

A

More SE than surgery or RT
Increased susceptibility to toxicity
Dose adjustment for reduced GFR or anemia (decreased treatment effectiveness)

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14
Q

Reasons for Increased Susceptibility to Toxicity

A

Decreased functional reserves
Co-existing disease
Altered metabolism & distribution of drugs
Poor stem cell recovery

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15
Q

Major Risks for Chemotherapy

A

Myelosuppression
Mucositis
Drug specific toxicities

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16
Q

Myelosuppression as a SE of Chemotherapy

A

Anemia: reduced O2 carying capacity
Neutropenia: sepsis
Thrombocytopenai: bleeding

17
Q

Mucositis as a SE of Chemotherapy

A

Dehydration
Malnutrition
Sepsis

18
Q

Drug Specific Toxicities as a SE of Chemotherapy

A

Renal insufficiency: platinum
Cardiotoxicity: anthracyclines
Neurotoxicity: platinum, taxanes, vincristine

19
Q

Cancer Treatment Decisions in Older Adults

A

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

20
Q

Physiologic Age

A

Good estimate of quality of life, life expectancy, & ability to tolerate cancer treatment

21
Q

Components of Physiologic Age

A

Co-morbidities
Functional status
Nutritional status
Geriatric syndromes

22
Q

Co-Morbidities of Interest

A 
CVD
Respiratory disease
Thromboembolic disease
DM
Renal insufficiency
Neurologic disease
Anemia
23
Q

Define Functional Status

A

Self care & the ability to maintain an independent life

24
Q

How to measure functional status in the elderly?

A

ADLs

IADLs

25
Q

Examples of ADLs

A 
Bathing
Dressing
Eating
Toileting
Continence
Transferring
26
Q

Examples of IADLs

A 
Use of transport
Shopping
Ability to take medications
Provide one's own meals
Manage finances
Do laundry & housekeeping
27
Q

Cancer Treatment Planning & Nutritional Status

A 
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
28
Q

Cancer Treatment Planning & Geriatric Syndromes

A 
Dementia
Delirium
Depression
Falls
Spontaneous fractures
Neglect & abuse
Incontinence
Nutritional problems
29
Q

Cancer Treatment Planning & Frailty

A

Yes: palliative
No: life prolonging treatment
Intermediate: individualize

30
Q

Supportive Care for the Elderly with Cancer Treatment

A 
Nutritional support
Anemia-epoitin alpha
Epogen or Leukine
Thrombocytopenia-platelet transfusion
Mucositis-supportive care
N/V serotonin receptor antagonists (ondansetron)
Pain control
31
Q

Nutritional Support for Cancer Treatment

A

Dietary counseling
Dietary supplements
Enteral feeding (G/J tube)

32
Q

Mucositis-Supportive Care for Cancer Treatment

A

Hydration
“Magic mouth wash”
Diet modification
Anti-diarrheals

33
Q

Atypical Presentation of Pain

A

Confusion
Fatigue
Withdrawal
Depression

34
Q

Communication Problems

A

Cognitive impairment
Language
Cultural factors

Geriatrics (15 decks)

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