Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-17T16:03:32.055Z Has data issue: false hasContentIssue false
  • English
  • Français

Cancer in the older person

Published online by Cambridge University Press:  24 August 2015

Emma Kelly  and
Peter Stephens
Emma Kelly*
Affiliation:
Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust
Peter Stephens
Affiliation:
Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust
*
Address for correspondence: Dr Emma Kelly, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

The challenges of treating malignant disease in the elderly population have gained greater prominence over the last 5–10 years. Developed nations all have ageing populations, and cancer in older people is an increasing physical and financial burden on both healthcare systems and populations.

When assessing oncology patients, oncologists have traditionally used the Eastern Cooperative Oncology Group or Karnofsky performance status. However, it has been shown that sometimes this does not detect potential problems in older patients, and that a comprehensive geriatric assessment may be a better tool. However good surgeons and oncologists are at adapting their services for older patients, there is little value if they are inappropriately referred or filtered out by either primary or secondary care.

Surgery forms the basis of most curative treatment options. The elderly have more peri-operative risk factors including multiple co-morbidities, poly-pharmacy, malnutrition, frailty, cognitive dysfunction and an increased anaesthetic risk, which can create obstacles.

Treating older patients with systemic cytotoxic therapy often relies on extrapolating evidence from younger patients. In previous decades, the majority of trials had upper age limits of 65 or 70 years. More recent trials normally include patients of all ages, and entry is based on performance status. Radiotherapy may be chosen as a potentially curative option in patients with an operable tumour, who are unfit. However, oncologists should not underestimate the burden that multiple frequent visits to hospital for treatment may have on an elderly patient population.

This article looks at the assessment of elderly oncology patients, referral patterns, surgery, systemic therapies, radiotherapy, supportive therapies and long-term side-effects from treatment.

Keywords

cancerchemotherapyradiotherapyperformance status
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 25 , Issue 3 , August 2015 , pp. 172 - 180
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Ries, L, Melbert, D, Krapcho, M, Stinchcomb, D, Howlader, N, Horner, Met al.SEER Cancer Statistics Review, 1975–2005. National Cancer Institute Bethesda, MD; 2008.Google Scholar
2Ferlay, J, Parkin, DM, Steliarova-Foucher, E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 2010; 46: 765–81.CrossRefGoogle ScholarPubMed
3Levi, F, Lucchini, F, Negri, E, La Vecchia, C. Continuing declines in cancer mortality in the European Union. Ann Oncol 2007; 18: 593–95.CrossRefGoogle ScholarPubMed
4Levi, F, Lucchini, F, Negri, E, Boyle, P, La Vecchia, C. Changed trends of cancer mortality in the elderly. Ann Oncol 2001; 12: 1467–77.CrossRefGoogle ScholarPubMed
5Chu, KC, Tarone, RE, Freeman, HP. Trends in prostate cancer mortality among black men and white men in the United States. Cancer 2003; 97: 1507–16.CrossRefGoogle ScholarPubMed
6Oken, MM, Creech, RH, Tormey, DC, Horton, J, Davis, TE, McFadden, ETet al.Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649–55.CrossRefGoogle ScholarPubMed
7Gridelli, C, Perrone, F, Gallo, C, De Marinis, F, Ianniello, G, Cigolari, Set al.Vinorelbine is well tolerated and active in the treatment of elderly patients with advanced non-small cell lung cancer. A two-stage phase II study. Eur J Cancer 1997; 33: 392–97.CrossRefGoogle ScholarPubMed
8Maione, P, Perrone, F, Gallo, C, Manzione, L, Piantedosi, F, Barbera, Set al.Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 2005; 23: 6865–72.CrossRefGoogle ScholarPubMed
9Yamazaki, H, Inoue, T, Yoshida, K, Imai, A, Yoshioka, Y, Tanaka, Eet al.Changes in performance status of elderly patients after radiotherapy. Radiat Med 2001; 19: 9–18.Google ScholarPubMed
10Lim, ST, Hee, SW, Quek, R, Tao, M. Performance status is the single most important prognostic factor in lymphoma patients aged greater than 75 overriding other prognostic factors such as histology. Leuk Lymphoma 2008; 49: 149–51.CrossRefGoogle ScholarPubMed
11Repetto, L, Fratino, L, Audisio, RA, Venturino, A, Gianni, W, Vercelli, Met al.Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002; 20: 494–502.CrossRefGoogle Scholar
12Hurria, A, Gupta, S, Zauderer, M, Zuckerman, EL, Cohen, HJ, Muss, Het al.Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 2005; 104: 1998–2005.CrossRefGoogle ScholarPubMed
13Terret, C, Albrand, G, Droz, JP. Multidimensional geriatric assessment reveals unknown medical problems in elderly cancer patients (pts). J Clin Oncol (Meeting Abstracts) 2004; 22 (14_suppl): 8167.CrossRefGoogle Scholar
14Gosney, MA. Clinical assessment of elderly people with cancer. Lancet Oncology 2005; 6: 790–97.CrossRefGoogle ScholarPubMed
15Richardson, A, Sitzia, J, Brown, V, Medina, J. Patients' needs assessment tools in cancer care: principles and practice. London: King's College London, 2005.Google Scholar
16Repetto, L, Venturino, A, Vercelli, M, Gianni, W, Biancardi, V, Casella, Cet al.Performance status and comorbidity in elderly cancer patients compared with young patients with neoplasia and elderly patients without neoplastic conditions. Cancer 1998; 82: 760–65.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
17Hurria, A, Wong, FL, Villaluna, D, Bhatia, S, Chung, CT, Mortimer, Jet al.Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol 2008; 26: 5386–92.CrossRefGoogle ScholarPubMed
18Al-Refaie, W, Parsons, H, Henderson, W, Jensen, E, Tuttle, Tet al.Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Annals Surgery 2010; 251: 311–18.CrossRefGoogle ScholarPubMed
19Korc-Grodzicki, B, Downey, R, Shahrokni, A, Kingham, T, Patel, Set al.Surgical considerations in older adults with cancer. J Clin Oncol 2014; doi 10.1200/JCO.2014.55.0962.CrossRefGoogle ScholarPubMed
20Morita, M, Otsu, H, Kawano, H, Kumashiro, R, Taketani, Ket al.Advances in esophageal surgery in elderly patients with thoracic esophageal cancer. Anticancer Res 2013; 33: 1641–47.Google ScholarPubMed
21Biondi, A, Grosso, G, Misretta, A, Marventano, S, Toscano, Cet al.Laparoscopic-assisted versus open surgery for colorectal cancer: short- and long-term outcomes comparison. J Laparoendosc Adv Surg Tech A 2013; 23: 1–7.CrossRefGoogle Scholar
22Forbes, JF, Cuzick, J, Buzdar, A, Howell, A, Tobias, JS, Baum, M. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 2008; 9: 45–53.Google ScholarPubMed
23Mouridsen, H, Giobbie-Hurder, A, Mauriac, L, Paridaens, R, Colleoni, M, Thuerlimann, Bet al. BIG 1–98: a randomized double-blind phase III study evaluating letrozole and tamoxifen given in sequence as adjuvant endocrine therapy for postmenopausal women with receptor-positive breast cancer. San Antonio Breast Cancer Symposium (meeting abstract); 2008.CrossRefGoogle Scholar
24Begg, CB, Cohen, JL, Ellerton, J. Are the elderly predisposed to toxicity from cancer chemotherapy? An investigation using data from the Eastern Cooperative Oncology Group. Cancer Clin Trials 1980; 3: 369–74.Google ScholarPubMed
25Tannock, IF, de Wit, R, Berry, WR, Horti, J, Pluzanska, A, Chi, KNet al.Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004; 351: 1502–12.CrossRefGoogle ScholarPubMed
26Gridelli, C. The ELVIS trial: a phase III study of single-agent vinorelbine as first-line treatment in elderly patients with advanced non-small cell lung cancer. Elderly Lung Cancer Vinorelbine Italian Study. Oncologist 2001; 6 (suppl 1): 4–7.CrossRefGoogle Scholar
27Gridelli, C, Cigolari, S, Gallo, C, Manzione, L, Ianniello, GP, Frontini, Let al.Activity and toxicity of gemcitabine and gemcitabine + vinorelbine in advanced non-small-cell lung cancer elderly patients: phase II data from the Multicenter Italian Lung Cancer in the Elderly Study (MILES) randomized trial. Lung Cancer 2001; 31: 277–84.CrossRefGoogle ScholarPubMed
28Wasil, T, Lichtman, SM, Gupta, V, Rush, S. Radiation therapy in cancer patients 80 years of age and older. Am J Clin Oncol 2000; 23: 526–30.CrossRefGoogle ScholarPubMed
29Jeremic, B, Milicic, B. From conventionally fractionated radiation therapy to hyperfractionated radiation therapy alone and with concurrent chemotherapy in patients with early-stage non-small cell lung cancer. Cancer 2008; 112: 876–84.CrossRefGoogle Scholar
30Lagerwaard, F, Haasbeek, C, Smit, E, Slotman, B, Senan, S. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2008; 70: 685–92.CrossRefGoogle ScholarPubMed
31Palma, D, Visser, O, Lagerwaard, FJ, Belderbos, J, Slotman, BJ, Senan, S. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol 2010; 28: 5153–59.CrossRefGoogle Scholar
32Spivak, J, Gascón, P, Ludwig, H. Anemia management in oncology and hematology. Oncologist 2009; 14 (suppl 1): 43–56.CrossRefGoogle ScholarPubMed
33Calabrich, A, Katz, A. Management of anemia in cancer patients. Future Oncol 2011; 7: 507–17.CrossRefGoogle ScholarPubMed
34Aapro, M, Link, H. September 2007 update on EORTC guidelines and anemia management with erythropoiesis-stimulating agents. Oncologist 2008; 13 (suppl 3): 33–6.CrossRefGoogle ScholarPubMed
35Vanasse, G, Berliner, N. Anemia in elderly patients: an emerging problem for the 21st century. Hematology Am Soc Hematol Educ Program 2010: 271–75.CrossRefGoogle Scholar
36Aapro, M, Bohlius, J, Cameron, D, Dal Lago, L, Donnelly, Jet al.2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 2011; 47: 8–32.CrossRefGoogle ScholarPubMed
37Rupolo, M, Lleshi, A, Cacopardo, B, Michieli, M, Berretta, M. Hematopoietic growth factors support in the elderly cancer patients treated with antiblastic chemotherapy. Anti-Cancer Agents Med Chem 2013; 13: 1438–43.CrossRefGoogle ScholarPubMed
38Glassock, RJ, Winearls, C. Ageing and the glomerular filtration rate: truths and consequences. Trans Am Clinical Climatological Assoc 2009; 120: 419–28.Google ScholarPubMed
39Malcolm, JB, Bagrodia, A, Derweesh, IH, Mehrazin, R, Diblasio, CJ, Wake, RWet al.Comparison of rates and risk factors for developing chronic renal insufficiency, proteinuria and metabolic acidosis after radical or partial nephrectomy. BJU Int 2009; 104: 476–81.CrossRefGoogle ScholarPubMed
40Efstathiou, E, Logothetis, CJ. Review of late complications of treatment and late relapse in testicular cancer. J Natl Compr Canc Netw 2006; 4: 1059–70.CrossRefGoogle ScholarPubMed
41Keefe, DL. Trastuzumab-associated cardiotoxicity. Cancer 2002; 95: 1592–600.CrossRefGoogle ScholarPubMed
42Seidman, A, Hudis, C, Pierri, MK, Shak, S, Paton, V, Ashby, Met al.Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 2002; 20: 1215–21.CrossRefGoogle ScholarPubMed
43Chen, J, Long, J, Hurria, A, Owusu, C, Steingart, Ret al.Incidence of heart failure or cardiomyopathy after adjuvant trastuzumab therapy for breast cancer. J Am Coll Cardiol 2012; 60: 2504–12.CrossRefGoogle ScholarPubMed