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Geriatrics > Cancer in the Elderly > Flashcards

Flashcards in Cancer in the Elderly Deck (34):
1

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

Aging

2

Cancer Biology & Aging

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

3

Cancers with an Indolent Course in the Elderly

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

4

Cancers that are More Aggressive in the Elderly

AML
Large cell non-Hodgkin lymphoma
Celomic ovarian cancer

5

Most Common Cancer Types in the Elderly

Breast
Prostate
Lung/bronchus
Colon & rectum

6

Reason Cancer Deaths Rates are so High

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

7

Age Bias in Cancer

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

8

Treatment Options for Cancer in the Elderly

Surgery
Radiation
Chemotherapy

9

Surgery for Cancer Treatment

Most effective of many malignancies
Relatively low mortality risk

10

Surgical Risk Factors for the Elderly

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

11

Radiation for Cancer Treatment

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

12

Major Risks of Radiation

Mucositis (dehydration, malnourishment, sepsis)
Radiation pneumonitis

13

Chemotherapy for Cancer Treatment

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

14

Reasons for Increased Susceptibility to Toxicity

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

15

Major Risks for Chemotherapy

Myelosuppression
Mucositis
Drug specific toxicities

16

Myelosuppression as a SE of Chemotherapy

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

17

Mucositis as a SE of Chemotherapy

Dehydration
Malnutrition
Sepsis

18

Drug Specific Toxicities as a SE of Chemotherapy

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

19

Cancer Treatment Decisions in Older Adults

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

20

Physiologic Age

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

21

Components of Physiologic Age

Co-morbidities
Functional status
Nutritional status
Geriatric syndromes

22

Co-Morbidities of Interest

CVD
Respiratory disease
Thromboembolic disease
DM
Renal insufficiency
Neurologic disease
Anemia

23

Define Functional Status

Self care & the ability to maintain an independent life

24

How to measure functional status in the elderly?

ADLs
IADLs

25

Examples of ADLs

Bathing
Dressing
Eating
Toileting
Continence
Transferring

26

Examples of IADLs

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

27

Cancer Treatment Planning & Nutritional Status

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

28

Cancer Treatment Planning & Geriatric Syndromes

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

29

Cancer Treatment Planning & Frailty

Yes: palliative
No: life prolonging treatment
Intermediate: individualize

30

Supportive Care for the Elderly with Cancer Treatment

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

31

Nutritional Support for Cancer Treatment

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

32

Mucositis-Supportive Care for Cancer Treatment

Hydration
"Magic mouth wash"
Diet modification
Anti-diarrheals

33

Atypical Presentation of Pain

Confusion
Fatigue
Withdrawal
Depression

34

Communication Problems

Cognitive impairment
Language
Cultural factors