Flashcards in Cancer in the Elderly Deck (34)
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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
