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Systemische Tumortherapie bei älteren Patienten

Systemic cancer treatment in geriatric patients

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Zusammenfassung

Hintergrund

Aspekte der reinen Lebenszeitverlängerung treten für ältere Patienten zunehmend in den Hintergrund und lassen die Bewertung eines Lebensjahres in Relation zur Gesundheit wichtiger erscheinen, was sich in den qualitätsadjustierten Lebensjahren widerspiegelt. Komorbiditäten und funktionelle bzw. kognitive Einschränkungen stellen unabhängige Prediktoren für das Gesamtüberleben geriatischer Patienten dar. Dies muss bei der Planung einer systemischen Tumortherapie Berücksichtigung finden.

Therapie

Eine systemische Tumortherapie muss dahingehend geprüft werden, ob sie dem Patienten unter Berücksichtigung geriatrischer Aspekte einen wirklichen Nutzen bringt. Dies stellt gerade an die palliative Chemotherapie höchste Ansprüche. In einer Situation, in der eine Kuration nicht mehr möglich ist, darf eine systemische Tumortherapie den Menschen nicht therapiebedingt symptomatisch werden lassen. Eine klare Formulierung der (Therapie-)Ziele in enger Absprache mit dem Patienten ist unerlässlich. Für die Beurteilung der altersbedingten Belastbarkeit eines Patienten in Vorbereitung auf eine systemische Tumortherapie müssen auch andere relevante Bereiche aktiv abgefragt werden, um ältere Menschen mit funktionalen und/oder kognitiven Einschränkungen, die möglicherweise nicht von einer systemischen Tumortherapie profitieren, zu erkennen.

Schlussfolgerung

Die Grundzüge der medikamentösen Therapie im Alter sind eine strenge Indikationsstellung unter Berücksichtigung altersphysiologischer Veränderungen bei klarer therpeutischer Priorisierung der Beschwerden.

Abstract

Background

Functional health issues and the ability to autonomously participate in social life play a more pronounced role for geriatric patients than the mere prolongation of life. Quality-adjusted life years reflect the relation of health and life span. Comorbidities and functional or cognitive impairment represent independent predictors for the overall survival of geriatric patients. This must be kept in mind when planning systemic cancer treatment.

Therapy

All forms of cancer-specific therapy should evaluate whether the patient can truly benefit taking into consideration geriatric aspects. This particularly demands a great deal of palliative chemotherapy. When curation is no longer possible, a cancer-specific treatment must not lead to therapy-related symptoms. Clear communication of the aims of therapy is indispensable. In addition to routine urooncologic data, other relevant information must be inquired in advance of cancer-specific treatment in order to identify those functionally or cognitively impaired patients who may not benefit from systemic cancer treatment.

Conclusion

A precise indication with respect of age-dependent physiological changes and a clear prioritization of symptoms outline the approach for systemic cancer-specific treatment.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Hess gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    J. Hess

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Hess, J. Systemische Tumortherapie bei älteren Patienten. Urologe 54, 1758–1764 (2015). https://doi.org/10.1007/s00120-015-4009-7

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