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Supportive Care in Cancer Therapy pp 249–268Cite as

Supportive Care of the Older Cancer Patient

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Part of the book series: Cancer Drug Discovery and Development ((CDD&D))

Abstract

Cancer mainly affects individuals aged 65 and over, so that supportive care for cancer treatment concerns mostly elderly patients. Age is a risk factor for increased incidence and severity of chemotherapy-related toxicity and also for the emergence of different forms of toxicity including delirium and malnutrition; in addition age may modulate the perception of pain and the response to analgesics, and may indicate the need of a caregiver.

The National Cancer Center Network (NCCN) guidelines recommend that all cancer patients aged 70 and older undergo some form of geriatric assessment, receive dose modification to the renal function for the first dose of chemotherapy, receive prophylactic filgrastim or peg-filgrastim for moderately cytotoxic chemotherapy, have hemoglobin levels maintained around 12 g dl−1 and be treated with drugs with best toxicity profiles when that is feasible.

Though the perception of pain may decline with age, pain is endemic in the older population. Special problems include assessment, especially in cognitively impaired elderly, reduced tolerance to nonsteroidal medications, and increased susceptibility to the complications of opioids.

Delirium is a common complication of hospitalized elderly and is associated with increased risk of functional decline and of mortality. A comprehensive geriatric assessment is helpful in the prevention of delirium.

The caregiver may represent the best ally of the practitioner in the management of the older cancer patient, in allowing patients to receive timely treatment and support during emergency, and in being the spokesperson for the family. It behooves the practitioner to advise, train, and support the caregiver.

Cancer is a disease of aging. Currently, 50% of all malignances occur in 12% of the population aged 65 and older. In the year 2030, older individuals will represent 20% of the population and account for 70% of all cancer (Balducci L., Aapro M., Epidemiology of cancer and aging. Cancer Treat Res 2005, 1–16). Clearly, cancer in the older aged person is becoming the most common form of cancer. In general, older individuals may need more supportive care than the younger ones, due to increased vulnerability to stress and reduced personal and social resources. This chapter highlights the special supportive needs of older individuals with cancer after a brief overview of the biology and clinics of aging.

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  1. Department of Interdisciplinary Oncology, Division of Geriatric Oncology,, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine,, 12902 Magnolia Drive, Tampa, FL 33612, USA

    Lodovico Balducci

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  1. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    David S. Ettinger

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Balducci , L. (2009). Supportive Care of the Older Cancer Patient. In: Ettinger, D.S. (eds) Supportive Care in Cancer Therapy. Cancer Drug Discovery and Development. Humana Press. https://doi.org/10.1007/978-1-59745-291-5_14

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