Supportive Care in Elderly Cancer Patients
It is widely accepted that after the age of 70 comorbidities become more frequent and organ function decreases. Supportive care in the elderly patient is based on the same principles as for younger patients, but elderly patients are at an increased risk of toxicity from any drug due to age-related decrease in organ function, use of polypharmacy with increased risk of drug–drug interactions, and due to comorbidity. The comprehensive geriatric assessment is a multidisciplinary evaluation of the older patient encompassing a number of essential clinical domains, which provides an important method to evaluate a patient who is to undergo a major medical procedure. The specificities of depression in elderly cancer patients remain a largely unexplored field of research. Not all tools for the assessment of pain are equally reliable in the elderly. Analgesics should be used with care in the elderly who are more susceptible to drug side effects. Guidelines on the use of granulocyte colony-stimulating factors recognize older individuals above the age of 65 as a group at high risk. Malnutrition is observed frequently and leads to low albumin levels, a determinant of toxicity for drug therapy. Compliance needs to be carefully evaluated, particularly in patients with high risk of noncompliance such as elderly with dementia and impaired vision. Osteopenia and osteoporosis are frequent in the elderly, both in females and males. Besides exercise and use of calcium and vitamin D, bisphosphonates or denosumab are recommended for some patients.
KeywordsZoledronic Acid Febrile Neutropenia Comprehensive Geriatric Assessment Elderly Cancer Patient Verbal Descriptor Scale
- 3.Extermann M, Aapro M, Bernabei R, et al. Task Force on CGA of the International Society of Geriatric Oncology. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 2005; 55:241–252.PubMedCrossRefGoogle Scholar
- 5.PACE participants, Audisio RA, Pope D, Ramesh HS, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008; 65:156–163.Google Scholar
- 24.Smith MR, Egerdie B, Hernández Toriz N, et al. Denosumab HALT Prostate Cancer Study Group. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. 2009; 361:745–755.Google Scholar