Rational Approach to Cancer in the Elderly

  • Frédérique Retornaz
  • Maud Cécile
  • Howard Bergman
Chapter

Abstract

In an era of an aging population with increased age-related cancer incidence, clinicians should expect that they will have to care for an ever growing number of elderly cancer patients. Colorectal cancer is the third most common cancer and the second most common cause of mortality in people aged over 65.

Whether at the screening, diagnosis, or treatment stage, there remains suboptimal treatment of cancer in the elderly. In most cases, the life expectancy of an elderly patient is often underestimated by the family and the physician. Underestimating the potential impact of cancer and life expectancy can expose an elderly patient to a high risk of loss of autonomy and of deterioration in the quality of life.

Colorectal cancer treatments are usually standardized but elderly patients may harbor multiple comorbidities, poor health status, geriatrics syndromes, and loss of functional reserve that will interfere with the treatment of the cancer itself. Optimizing these, complex patient relies on an accurate prediction of outcomes. Till today, no standardized assessment can be recommended. Studies are ongoing to find the best screening tools, best geriatric assessment, and best interventions especially in the setting of surgery.

Keywords

Colorectal Cancer Elderly Patient Life Expectancy National Comprehensive Cancer Network National Comprehensive Cancer Network 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Aapro MS, Kohne CH, Cohen HJ et al (2005) Never too old? Age should not be a barrier to enrolment in cancer clinical trials. Oncologist 10:198–204PubMedCrossRefGoogle Scholar
  2. Aouba A, Péquignot F, Le Toullec A, et al (2007) Les causes médicales de décès en France en 2004 et leur évolution 1980–2004. Bulletin Epidémiologique Hebdomadaire 35–36:308–14. http://www.insee.fr
  3. Aparicio T, Mitry E, Sa Cunha A et al (2005) Management of colorectal cancer of elderly patients. Gastroenterol Clin Biol 29:1014–1023PubMedCrossRefGoogle Scholar
  4. Aparicio T, Navazesh A, Boutron I et al (2009) Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment. Crit Rev Oncol Hematol 71:249–257PubMedCrossRefGoogle Scholar
  5. Aparicio T, Bouché O, Carola E et al (2010) Recommandations du GEPOG (Groupe d’ Echanges et de Pratique en Onco-Geriatrie) pour le traitement des cancers colorectaux métastatiques des patients âgés. Journal d’Onco-Gériatrie 3(4):157–163Google Scholar
  6. Balducci L, Beghe C (2000) The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Hematol 35:147–154PubMedCrossRefGoogle Scholar
  7. Benson AB III, Pregler JP, Bean JA et al (1991) Oncologists’ reluctance to accrue patients onto clinical trials: an Illinois Cancer Center study. J Clin Oncol 9:2067–2075PubMedGoogle Scholar
  8. Bernabei R, Venturiero V, Tarsitani P et al (2000) The comprehensive geriatric assessment: when, where, how. Crit Rev Oncol Hematol 33:45–56PubMedCrossRefGoogle Scholar
  9. Brouquet A, Cudennec T, Benoist S et al (2010) Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg 251:759–765PubMedCrossRefGoogle Scholar
  10. Carreca I, Balducci L, Extermann M (2005) Cancer in the older person. Cancer Treat Rev 31:380–402PubMedCrossRefGoogle Scholar
  11. Chen CC, Kenefick AL, Tang ST et al (2004) Utilization of comprehensive geriatric assessment in cancer patients. Crit Rev Oncol Hematol 49:53–67PubMedCrossRefGoogle Scholar
  12. Dasgupta M, Dumbrell AC (2006) Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 54:1578–1589PubMedCrossRefGoogle Scholar
  13. Diab SG, Elledge RM, Clark GM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92:550–556PubMedCrossRefGoogle Scholar
  14. Extermann M, Aapro M, Bernabei R, Task Force on CGA of the International Society of Geriatric Oncology et al (2005) 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 55:241–252PubMedCrossRefGoogle Scholar
  15. Extermann M, Boler I, Reich RR et al (2011) Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. doi: 10.1002/cncr.26646
  16. Fentiman IS, Tirelli U, Monfardini S et al (1990) Cancer in the elderly: why so badly treated? Lancet 335:1020–1022PubMedCrossRefGoogle Scholar
  17. Ferrucci L, Guralnik JM, Cavazzini C et al (2003) The frailty syndrome: a critical issue in geriatric oncology. Crit Rev Oncol Hematol 46:127–137PubMedCrossRefGoogle Scholar
  18. Goodwin JS, Hunt WC, Samet JM (1993) Determinants of cancer therapy in elderly patients. Cancer 72:594–601PubMedCrossRefGoogle Scholar
  19. Goodwin JS, Samet JM, Hunt WC (1996) Determinants of survival in older cancer patients. J Natl Cancer Inst 88:1031–38. http://www.iinsee.fr Google Scholar
  20. Hurria A, Togawa K, Mohile SG et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29:3457–3465PubMedCrossRefGoogle Scholar
  21. Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341:2061–2067PubMedCrossRefGoogle Scholar
  22. Inouye S (2006) Delirium in older persons. N Engl J Med 354:1157–1165PubMedCrossRefGoogle Scholar
  23. Inouye S, Bogardus S, Charpentier P et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676PubMedCrossRefGoogle Scholar
  24. Janssen-Heijnen ML, Maas HA, Houterman S et al (2007) Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 43(15):2179–2193PubMedCrossRefGoogle Scholar
  25. Kunitake H, Zingmond D, Ryoo J et al (2010) Caring for octogenarian and nonagenarian patients with colorectal cancer: what should our standards and expectations be? Dis Colon Rectum 53:735–743PubMedCrossRefGoogle Scholar
  26. Lee SJ, Lindquist K, Segal MR et al (2006) Development and validation of a prognostic index for 4-year mortality in older adults. JAMA 295:801–808PubMedCrossRefGoogle Scholar
  27. Luciani A, Ascione G, Bertuzzi C et al (2010) Detecting disabilities in older patients with cancer: comparison between comprehensive geriatric assessment and vulnerable elders survey-13. J Clin Oncol 28:2046–2050PubMedCrossRefGoogle Scholar
  28. Maas HA, Janssen-Heijnen ML, Olde Rikkert MG et al (2007) Comprehensive geriatric assessment and its clinical impact in oncology. Eur J Cancer 43:2161–2169PubMedCrossRefGoogle Scholar
  29. Makary MA, Segev DL, Pronovost PJ et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210:901–908PubMedCrossRefGoogle Scholar
  30. Misra D, Seo PH, Cohen HJ (2004) Aging and cancer. Clin Adv Hematol Oncol 2:457–465PubMedGoogle Scholar
  31. Papamichael D, Audisio R, Horiot J-C et al (2009) Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol 16:20–25Google Scholar
  32. Puts MT, Monette J, Girre V et al (2011) Are frailty markers useful for predicting treatment toxicity and mortality in older newly diagnosed cancer patients? Results from a prospective pilot study. Crit Rev Oncol Hematol 78:138–149PubMedCrossRefGoogle Scholar
  33. Quipourt V, Jooste V, Cottet V et al (2011) Comorbidities alone do not explain the undertreatment of colorectal cancer in older adults: a French population-based study. J Am Geriatr Soc 59:694–698PubMedCrossRefGoogle Scholar
  34. Raji M, Kuo Y-F, Freeman J et al (2008) Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer implications for cancer care. Arch Intern Med 168:2033–2040PubMedCrossRefGoogle Scholar
  35. Repetto L, Venturino A, Fratino L et al (2003) Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer 39:870–880PubMedCrossRefGoogle Scholar
  36. Retornaz F, Monette J, Batist G et al (2008) Usefulness of frailty markers in the assessment of health and functional status of older cancer patients referred for chemotherapy: a pilot study. J Gerontol A Biol Sci Med Sci 63:518–522PubMedCrossRefGoogle Scholar
  37. Retornaz F, Potard I, Molines C et al (2010) Quand l’équipe gériatrique restaure la confiance de l’équipe médico-chirurgicale. Journal d’Onco-Gériatrie 1:33–36Google Scholar
  38. Sieber F (2009) Post operative delirium in the elderly surgical patient. Anesthesiol Clin 27:451–464PubMedCrossRefGoogle Scholar
  39. Stuck AE, Siu AL, Wieland GD et al (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342:1032–1036PubMedCrossRefGoogle Scholar
  40. Tan E, Tilney H, Thompson M et al (2007) The United Kingdom national bowel cancer project – epidemiology and surgical risk in the elderly. Eur J Cancer 43:2285–2294PubMedCrossRefGoogle Scholar
  41. Tan KY, Kawamura YJ, Tokomitsu A et al (2011) Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg [Epub ahead of print]Google Scholar
  42. Turner N, Haward R, Mulley G et al (1999) Cancer in old age: is it inadequately investigated and treated? BMJ 319:309–312PubMedCrossRefGoogle Scholar
  43. Townsley CA, Naidoo K, Pond GR et al (2003) Are older cancer patients being referred to oncologists? A mail questionnaire of Ontario primary care practitioners to evaluate their referral patterns. J Clin Oncol 21:4627–4635PubMedCrossRefGoogle Scholar
  44. Tyldesley S, Zhang-Salomons J, Groome PA et al (2000) Association between age and the utilization of radiotherapy in Ontario. Int J Radiat Oncol Biol Phys 47:469–480PubMedCrossRefGoogle Scholar
  45. Vercelli M, Capocaccia R, Quaglia A et al (2000) Relative survival in elderly European cancer patients: evidence for health care inequalities. The EUROCARE Working Group. Crit Rev Oncol Hematol 35:161–179PubMedCrossRefGoogle Scholar
  46. Walter LC, Brand RJ, Counsell SR et al (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285(23):2987–2994PubMedCrossRefGoogle Scholar
  47. Yancik R, Ries LA (2000) Aging and cancer in America. Demographic and epidemiologic perspectives. Hematol Oncol Clin North Am 14:17–23PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Frédérique Retornaz
    • 1
    • 2
  • Maud Cécile
    • 3
  • Howard Bergman
    • 4
    • 5
  1. 1.Unité de coordination en oncogériatrie (UCOG)Centre Gérontologique DépartementalMarseilleFrance
  2. 2.EA3279. Evaluation des Systèmes de Soins – Santé PerçueUniversité de la MéditerranéeMarseilleFrance
  3. 3.Unité pilote de coordination en oncogériatrie (UPCOG)Institut Paoli CalmettesMarseilleFrance
  4. 4.Division of Geriatric MedicineJewish General HospitalMontrealCanada
  5. 5.Solidage Research Group on Integrated Services for Older Persons, Centre for Clinical Epidemiology and Community Studies, Jewish General HospitalMontrealCanada

Personalised recommendations