Cancer in Elderly

Česká verzia

Authors: J. Petera ¹; L. Dušek ²
Authors place of work: Klinika onkologie a radioterapie LF UK a FN Hradec Králové ¹; Institut biostatistiky a analýz, LF a PřF MU, Brno ²
Published in the journal: Klin Onkol 2014; 27(3): 210-218
Category: Short Communication

Summary

Background:
Population ageing in developed countries associated with increasing cancer incidence in higher age categories becomes a serious challenge in oncology nowadays.

Aim:
To review the present policy of management of senior cancer patients and to outline strategies of its improvement. Elderly patiens are generally undertreated if we address current treatment standards. The elderly population is heterogenous in terms of functional status, physical and psychical impairment, comorbidities, functional reserve, socioeconomic backgroud and geriatric symptoms. There is a lack of consensus on guidelines for elderly population due to underrepresentation of older patiens in clinical trials. Geriatric assessments could be a useful tool for medical decision making and adjusting treatment plan for a certain group of patients – those suitable for standard treatment, vulnerable group – advisable to treatment reduction, and frail patients – indicated for paliative approach. However, studies confirming effectiveness of this age-specific approach in comparison with routine clinical practice remain to be conducted.

Conclusion:
Clinical studies focused on senior cancer patients are urgently needed.

Key words:
elderly – cancer – treatment – geriatric assessment

This study was supported by the program PRVOUK P37/06.

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
2. 12. 2013

Accepted:
29. 1. 2014

Zdroje

1. Ústav zdravotnických informací a statistiky ČR. Novotvary 2009. Praha: ÚZIS ČR 2012.

2. Edwards BK, Howe HL, Ries LA et al. Annual report to the nation on the status of cancer, 1973– 1999, featuring implications of age and aging on US cancer burden. Cancer 2002; 94(10): 2766– 2792.

3. Petera J, Dušek L. Cancer in the elderly. Rep Pract Oncol Radiother 2012; 18(1): 1– 5. doi: 10.1016/ j.rpor.2012.11.001.

4. Chen RC, Bainbridge K, Carpenter WE et al. Racial differences in receipt of guideline‑ recommended treatment in men with low‑ , intermediate‑ , and high‑risk prostate cancor (CaP). A population based study. J Clin Oncol 2010; 28 (Suppl): 15.

5. Lu‑ Yao GL, Albertsen PC, Moore DF et al. Outcomes of localized prostate cancer following conservative management. JAMA 2009; 302(11): 1202– 1209. doi: 10.1001/ jama.2009.1348.

6. Soumarová R, Homola L, Perková H. Long term results of HDR brachytehrapy in men older than 75 with localized carcinoma of the prostate. Rep Pract Oncol Radiother 2012; 18(1): 11– 15. doi: 10.1016/ j.rpor.2012.08.005.

7. Fedeli U, Fedewa SA, Ward EM. Treatment of muscle invasive bladder cancer: evidence from the national cancer database 2003 to 2007. J Urol 2011; 185(1): 72– 78. doi: 10.1016/ j.juro.2010.09.015.

8. Tesarova P. Brest cancer in the elderly – should it be treated differently? Rep Pract Oncol and Radiother 2012; 18(1): 26– 33.

9. Wo JY, Hong TS, Lisa AK. Impact of age and comorbidities on the treatment of gastrointestinal malignancies. Semin Radiat Oncol 2012; 22(4): 311– 320. doi: 10.1016/ j.semradonc.2012.05.008.

10. Gugić J, Strojan P. Squamous cell carcinoma of the head and neck in the elderly. Rep Pract Oncol Radiother 2012; 18(1): 16– 25.

11. Truong PT, Kader HA, Lacy B et al. The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer. Am J Clin Oncol 2005; 28(2): 157– 164.

12. Louwman WJ, Janssesn‑ Heijnen ML, Houiterman S et al.Less extensive treatment and inferior prognosis for brest cancer patient with comorbidity: a population‑based study. Eur J Cancer 2005; 41(5): 779– 785.

13. Hewitt M, Rolland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci 2003; 58(1): 82– 91.

14. Scher KS, Hurria A. Under‑ representation of older adults in cancer registration trials: known problem, little progress. J Clin Oncol 2012; 30(17): 2036– 2038. doi: 10.1200/ JCO.2012.41.6727.

15. Basche M, Baron AE, Eckhardt SG et al. Barriers to enrolment of elderly adults in early phase cancer clinical trials. J Oncol Pract 2008; 4(4): 162– 168. doi: 10.1200/ JOP.0842001.

16. Kaźmierska J. Do we protect or discriminate? Representation of senior adults in clinical trials. Rep Pract Oncol Radiother 2013; 18(1): 6– 10. doi: 10.1016/ j.rpor.2012.08.006.

17. Kaźmierska J. Assessement of health status in elderly patiens with cancer. Rep Pract Oncol Radiother 2012; 18(1): 44– 48. doi: 10.1016/ j.rpor.2012.07.007.

18. Zadak Z, Ticha A, Hyšpler R. Disease specific substrates in cancer cachexia – reality and anticipation. Rep Pract Oncol Radiother 2012; 18(1): 34– 43.

19. Cacicedo J, Caquero F, Martinez‑ Indart L et al. Detection of risk factors that influence weight loss in patiens undergoing radiotherapy. Rep Pract Oncol Radiother 2012; 17(5): 269– 275.

20. Cieślak K. Professional psychological support and psychotherapy methods for oncology patiens. Basic concepts and issues. Rep Pract Oncol Radiother 2013; 18(3): 121– 126.

21. Extermann M. Integrating a geriatric evaluation in the clinical setting. Semin Radiat Oncol 2012; 22(4): 272– 276. doi: 10.1016/ j.semradonc.2012.05.003.

22. Balducci L, Extermann M. Management of cancer in older persons: a practical approach. Oncologist 2000; 5(3): 224– 237.

23. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Med Sci 2001; 56(3): M146– M156.

24. Hemaker ME, Vos AG, Smorenburg CH et al. The value of geriatric assessments in predicting treatment tolerance and all‑cause mortality in older patiens with cancer. Oncologist 2012; 17(11): 1349– 1449. doi: 10.1634/ theoncologist.2012– 0186.

25. Mishra MV, Showalter TN, Dicker AP. Biomarkers of aging and radiation therapy tailored ot the elderly: future of the field. Semin Radiat Oncol 2012, 22(4): 334– 338. doi: 10.1016/ j.semradonc.2012.05.010.