Cancer in the Elderly

Question 1

What is the single biggest risk factor in the development of cancer?

Answer 1

Aging

Question 2

Cancer Biology & Aging

Answer 2

Blunted T-cell & NK cell activity
IL-6 increases
Angiogenesis is altered
Chronic inflammation may promote tumor growth

Question 3

Cancers with an Indolent Course in the Elderly

Answer 3

Non-small cell lung adenocarcinomas
Estrogen/progesterone responsive positive breast cancers
Prostate cancer

Question 4

Cancers that are More Aggressive in the Elderly

Answer 4

AML
Large cell non-Hodgkin lymphoma
Celomic ovarian cancer

Question 5

Most Common Cancer Types in the Elderly

Answer 5

Breast
Prostate
Lung/bronchus
Colon & rectum

Question 6

Reason Cancer Deaths Rates are so High

Answer 6

Organ vulnerability
Co-existing illnesses
More aggressive tumors
More likely to have advance disease at presentation
Age bias

Question 7

Age Bias in Cancer

Answer 7

“Treatment too dangerous for elderly”
Reduced participation in cancer screening programs
Under-representation in clinical trials
Health care access issues

Question 8

Treatment Options for Cancer in the Elderly

Answer 8

Surgery
Radiation
Chemotherapy

Question 9

Surgery for Cancer Treatment

Answer 9

Most effective of many malignancies

Relatively low mortality risk

Question 10

Surgical Risk Factors for the Elderly

Answer 10

Emergency surgery or prolonged surgery
Co-morbidities
Poor nutritional status
Poor functional status

Question 11

Radiation for Cancer Treatment

Answer 11

Safe & effective curative & palliative therapy for localized cancers
Short course RT & brachytherapy very safe & convenient

Question 12

Major Risks of Radiation

Answer 12

Mucositis (dehydration, malnourishment, sepsis)

Radiation pneumonitis

Question 13

Chemotherapy for Cancer Treatment

Answer 13

More SE than surgery or RT
Increased susceptibility to toxicity
Dose adjustment for reduced GFR or anemia (decreased treatment effectiveness)

Question 14

Reasons for Increased Susceptibility to Toxicity

Answer 14

Decreased functional reserves
Co-existing disease
Altered metabolism & distribution of drugs
Poor stem cell recovery

Question 15

Major Risks for Chemotherapy

Answer 15

Myelosuppression
Mucositis
Drug specific toxicities

Question 16

Myelosuppression as a SE of Chemotherapy

Answer 16

Anemia: reduced O2 carying capacity
Neutropenia: sepsis
Thrombocytopenai: bleeding

Question 17

Mucositis as a SE of Chemotherapy

Answer 17

Dehydration
Malnutrition
Sepsis

Question 18

Drug Specific Toxicities as a SE of Chemotherapy

Answer 18

Renal insufficiency: platinum
Cardiotoxicity: anthracyclines
Neurotoxicity: platinum, taxanes, vincristine

Question 19

Cancer Treatment Decisions in Older Adults

Answer 19

Should be based on tumor characteristics
Patient’s functional status
Risk vs. benefit & effects of quality vs. quantity of life
Patients treatment goals
Avoid under treatment of curable disease
Avoid over treatment of indolent cancers or cancers with poor prognosis

Question 20

Physiologic Age

Answer 20

Good estimate of quality of life, life expectancy, & ability to tolerate cancer treatment

Question 21

Components of Physiologic Age

Answer 21

Co-morbidities
Functional status
Nutritional status
Geriatric syndromes

Question 22

Co-Morbidities of Interest

Answer 22

CVD
Respiratory disease
Thromboembolic disease
DM
Renal insufficiency
Neurologic disease
Anemia

Question 23

Define Functional Status

Answer 23

Self care & the ability to maintain an independent life

Question 24

How to measure functional status in the elderly?

Answer 24

ADLs

IADLs

Question 25

Examples of ADLs

Answer 25

``` Bathing Dressing Eating Toileting Continence Transferring ```

Question 26

Examples of IADLs

Answer 26

``` Use of transport Shopping Ability to take medications Provide one's own meals Manage finances Do laundry & housekeeping ```

Question 27

Cancer Treatment Planning & Nutritional Status

Answer 27

``` Protein/calorie malnutrition Weight loss: >10 pounds over 6 months Loss of muscle mass BMI less than 20 Serum albumin: less than 3.2 g/dL ```

Question 28

Cancer Treatment Planning & Geriatric Syndromes

Answer 28

``` Dementia Delirium Depression Falls Spontaneous fractures Neglect & abuse Incontinence Nutritional problems ```

Question 29

Cancer Treatment Planning & Frailty

Answer 29

Yes: palliative No: life prolonging treatment Intermediate: individualize

Question 30

Supportive Care for the Elderly with Cancer Treatment

Answer 30

``` Nutritional support Anemia-epoitin alpha Epogen or Leukine Thrombocytopenia-platelet transfusion Mucositis-supportive care N/V serotonin receptor antagonists (ondansetron) Pain control ```

Question 31

Nutritional Support for Cancer Treatment

Answer 31

Dietary counseling Dietary supplements Enteral feeding (G/J tube)

Question 32

Mucositis-Supportive Care for Cancer Treatment

Answer 32

Hydration "Magic mouth wash" Diet modification Anti-diarrheals

Question 33

Atypical Presentation of Pain

Answer 33

Confusion Fatigue Withdrawal Depression

Question 34

Communication Problems

Answer 34

Cognitive impairment Language Cultural factors