Cancer in the elderly

Cancer is the leading cause of death in adults a 60-79 years.

With 50% of all cancers and more than 70% of cancer related deaths in the US occur in  patient’s age 65 years or older. 

The aging of the US population and increasing life expectancy is suggested that cancer in older adults is becoming increasingly prevalent.

Benefits of treatment must outweigh the risks in a population with a decreased life expectancy, comorbidities, and decreased tolerance to stress.

Certain cancers and their responsiveness to treatment are different in older patients compared with their younger counterparts. 

Physiologic changes associated with aging impact the elderly‘s ability to tolerate cancer therapy and is considered in the treatment decision making process.

Pre-treatment evaluation includes patient’s function, mobility, comorbidities, social functioning, available support, cognition, psychological status, nutrition, polypharmacy, nutritional and caregiver concerns.

Estimating life expectancy is important when making treatment decisions.

The availability of social support is associated with physical health and emotional well-being of patients with cancer, and older adults with cancer require dependable social support systems to optimize treatment outcomes.

Lack of social ties has been identified as a significant predictor of mortality in older adults.

Older patients with cancer who are impaired cognitively have increased functional dependency, depression, and increased mortality equivalent to that with a diagnosis of cancer.

Depression and distress has been identified in approximately 28 and 41% of older adults with cancer, respectively.

Nutritional deficiency or malnutrition is common in older adults and specifically with those with cancer and is associated with increased risk of toxicity, increased mortality risk, poor chemotherapy tolerance and increased length of stay in hospitalized cancer patients.

Polypharmacy in older patients due to the presence of comorbidities increases incidence of adverse drug reactions, drug to drug interactions, and non-adherence.

Elderly patients have alterations in formal kinetics and pharmacodynamics of drug metabolism which can contribute to adverse drug interactions.

The use of potentially inappropriate medications: hypnotics, sedatives, antidepressants, benzodiazepines and other inappropriate psychotropics and medications with anticholinergic properties are also associated with increased risk of falls in older adults.

Time up and go (TUG) test-A test for use to assess function and mobility in older adults.

Gait speed may be helpful in identifying older patients with a longer life expectancy and who may be candidates for preventive interventions that are associated with long-term benefit. 

A decline in gait speed is characterized as slow, moderate, or fast it could predict mortality and well functioning older adults.

Older adults have an increase prevalence of comorbidities that may impact life expectancy, cancer prognosis, and treatment tolerance.







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