Symptom Management in Geriatric Oncology: Practical Treatment Considerations and Current Challenges

Geriatric Oncology

Opinion statement

Symptom management of the actively treated elderly cancer patient represents an undertreated and disproportionately understudied cohort in oncology. There is a dearth of specific recommendations or guidelines regarding drug selection, dosing, and side effects which account for changes in aging physiology, pharmacokinetics, and idiosynchratic reactions. In treating cardinal symptoms and clusters of symptoms including pain, constipation, fatigue/weakness, nausea/vomiting, mucositis/xerostomia, and nutritional depletion syndromes such as malabsorption and anorexia/cachexia, most clinicians base their therapeutic decisions on individual experience. Depending on relative interest and level of competency, symptom management is often narrow in scope, frequently ineffective, and not based on evidence. We discuss these issues in a practical format, by surveying and comparing available core literature to the extent that it readily exists and by incorporating our own experiences.

References and Recommended Reading

  1. 1.
    Aapro M, Macciocchi A, Gridelli C. Palonosetron improves prevention of chemotherapy-induced nausea and vomiting in elderly patients. J Support Oncol 2005; 3(5):369–374PubMedGoogle Scholar
  2. 2.
    Horiot JC, Aapro M. Treatment implications for radiation-induced nausea and vomiting in specific patient groups. Euro J Cancer 2004; 40(7):979–987. doi:10.1016/j.ejca.2003.12.023 CrossRefGoogle Scholar
  3. 3.
    Esbensen BA, Osterlind K, Hallberg IR. Quality of life of elderly persons with cancer: A 6-month follow-up. Scand J Caring Sci 2007; 21(2):178–190. doi:10.1111/j.1471-6712.2007.00454.x CrossRefPubMedGoogle Scholar
  4. 4.
    Clark PM. Pharmacologic pain management in the elderly cancer patient. 2001. www.medscape.com/viewarticle/418569
  5. 5.
    Bernabei R, Gambassi G, Lapane K, et al. Management of pain in elderly patients with cancer. JAMA 1998; 279(23):1877–1882. doi:10.1001/jama.279.23.1877 CrossRefPubMedGoogle Scholar
  6. 6.
    Delgado-Guay MO, Bruera E. Management of pain in the older person with cancer. Part 1 Oncol 2008, 22(1):56–61; Part 2 Oncol 2008, 22(2):148–152Google Scholar
  7. 7.
    Vigano A, Bruera E, Suarez-Almazor ME. Age, pain intensity, and opioid dose in patients with advanced cancer. Cancer 1998, 83:1244–1250. doi:10.1002/(SICI)1097-0142(19980915)83:6<1244::AID-CNCR26>3.0.CO;2-4Google Scholar
  8. 8.
    Van den Beuken-van Everdingen MHJ, de Riike JM, et al. Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annal Oncol 2007; 18(9):1437–1449Google Scholar
  9. 9.
  10. 10.
    Assessing and Managing Narcotic-Induced Constipation. Cancer Contr J Moffitt Cancer Center. www.medscape.com/viewarticle/417707_8
  11. 11.
    Portenoy RK. Cancer-related fatigue: an immense problem. Oncologist 2000; 5(5):350–352. doi:10.1634/theoncologist.5-5-350 CrossRefPubMedGoogle Scholar
  12. 12.
    Rao A, Cohen HJ. Symptom management in elderly cancer patient: fatigue, pain, and depression. J Nat Cancer Inst Monogr 2004; 32:150–157. doi:10.1093/jncimonographs/lgh031 CrossRefGoogle Scholar
  13. 13.
    Tumor-Induced Effects on Nutritional Status. National Cancer Institute. www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/HealthProfessionals/page3
  14. 14.
    Zagaria, MAE. Nutrition in the elderly. US Pharmacist A Jocobson Publication. www.uspharmacist.com
  15. 15.
    Paillaud E, Caillet P, Campillo B, et al. Increased risk of alteration of nutritional status in hospitalized elderly patients with advanced cancer. J Nutrit Health Aging 2006; 10(2):91–95Google Scholar
  16. 16.
    Barber MD, Ross JA, Voss AC, et al. The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer. Brit J Cancer 1999; 81(1): 80–86. doi:10.1038/sj.bjc.6690654 CrossRefPubMedGoogle Scholar
  17. 17.
    Argiles JM, Lopez-Soriano FJ, Busquets S. Novel approaches to the treatment of cachexia. Drug Discov Today 2008; 13(1/2): 73–77. doi:10.1016/j.drudis.2007.10.008 CrossRefPubMedGoogle Scholar
  18. 18.
    Murphy B. Clinical and economic consequences of mucositis induced by chemotherapy and/or radiation therapy. J Support Oncol 2007; 5(9): 13–21PubMedGoogle Scholar
  19. 19.
    Sonis ST. Oral mucositis in cancer therapy. J Support Oncol 2004; 2(3):3–8PubMedGoogle Scholar
  20. 20.
    Barasch A, Peterson DE. Risk factors for ulcerative oral mucositis in cancer patients: unanswered questions. Oral Oncol 2003; 39(2): 91–100. doi:10.1016/S1368-8375(02)00033-7 CrossRefPubMedGoogle Scholar
  21. 21.
    Koestler WJ, Hejna M, Wenzel C, et al. Oral mucositis complicating chemotherapy and/or radiotherapy: options for prevention and treatment. CA: A Cancer J Clin 2001; 51: 290–315CrossRefGoogle Scholar
  22. 22.
    Elting LS, Cooksley C, Chambers M, et al. The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis. Cancer 2003; 98:1531–1539. doi:10.1002/cncr.11671 CrossRefPubMedGoogle Scholar
  23. 23.
    Guidelines for the treatment of elderly cancer patients. Medscape Today for Web MD. www.medscape.com/viewarticle/465306-9
  24. 24.
    Rubenstein EB, Peterson DE, Schubert M, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer 2004; 100(9): 2026–2046. doi:10.1002/cncr.20163 CrossRefPubMedGoogle Scholar
  25. 25.
    DiGangi P. Polypharmacy in older adults. Contemp Oral Hygiene Feb 2006. www.contemporaryoralhygieneonline.com/issues/articles/2006-02-03.asp
  26. 26.
    Papas AS, Clark RE, et al. A prospective randomized trial for the prevention of mucositis in patients undergoing bone marrow transplant. Bone Marrow Trans 2003; 31(8): 705–712. doi:10.1038/sj.bmt.1703870 CrossRefGoogle Scholar
  27. 27.
    Gridelli C. Same old story? Do we need to modify our supportive care treatment of elderly cancer patients? Focus on antiemetics. Drug Aging 2004; 21(13): 825–832. doi:10.2165/00002512-200421130-00001 CrossRefGoogle Scholar
  28. 28.
    Aapro M, Johnson J. Chemotherapy-induced emesis in elderly cancer patients: The role of 5-HT3-receptor antagonists in the first 24 hours. Gerontology 2005; 51(1): 287–296. doi:10.1159/000086364 CrossRefPubMedGoogle Scholar
  29. 29.
    Aapro M. Optimising antiemetic therapy: what are the problems and how can they be overcome?. Curr Med Res Opin 2005; 21(6): 885–897. doi:10.1185/030079905X46313 CrossRefPubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  • Katharine L. Barford
    • 1
    • 2
  • James T. D’Olimpio
    • 1
    • 2
  1. 1.The Don Monti Division of Medical OncologyNorth Shore University HospitalManhassetUSA
  2. 2.Monter Cancer CenterLake SuccessUSA

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