Comprehensive Geriatric Assessment in the Elderly Cancer Patient

Friedrich, Christoph; Kolb, Gerald; Wedding, Ulrich; Pientka, Ludger

doi:10.1159/000072096

Cited by 40 publications

(19 citation statements)

References 46 publications

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“…Since elderly patients are usually unable to tolerate these symptoms very well, therapeutic interventions should focus on relief of symptoms, improvements in life quality, and, if possible, prolongation of survival. A comprehensive geriatric assessment may be useful to evaluate comorbidity and functional status in order to establish appropriate and individualized treatment goals [20].…”

Section: Treatment Options For Symptomatic Diseasementioning

confidence: 99%

Modern Treatment Options for Elderly Patients with Multiple Myeloma

Görner

Späth‐Schwalbe²

2008

Onkologie

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Multiple myeloma, an incurable malignancy of plasma cells, is a disease of the elderly. In younger patients, significant therapeutic progress has been achieved, but survival outcomes remain unacceptably low in older adults with multiple myeloma. Diverse factors, including comorbidity, performance status, decreased physiologic reserve, and potential undertreatment, contribute to these poor outcomes. Unfortunately, many clinical trials are designed to exclude elderly patients with coexisting diseases, so only limited data are available and no guidelines exist on how to treat this challenging and growing myeloma population. A broader range of therapeutic options has become available within the last few years, including chemotherapy with either established or newly available drugs, immunomodulators, and high-dose treatment with stem cell support (autologous as well as allogeneic). In this review, we discuss the data available from clinical trials investigating antineoplastic treatment of elderly multiple myeloma patients.

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Section: Treatment Options For Symptomatic Diseasementioning

confidence: 99%

Modern Treatment Options for Elderly Patients with Multiple Myeloma

Görner

Späth‐Schwalbe²

2008

Onkologie

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“…It seems typical for the situation of elderly patients with AML that the 5 German trial groups agreed upon a common treatment approach for younger patients ('Intergroup Trial') but not for elderly patients, who represent the majority of patients with AML. The inclusion of a patient assessment into clinical trials for elderly patients with AML will help to improve the treatment decision, to define those patients which benefit from a therapy based on characteristics of their leukaemia and which tolerate intensive induction therapy without fatal toxicity, and to make patients comparable between different trials [48].…”

Section: Trialsmentioning

confidence: 99%

Elderly Patients with Acute Myeloid Leukaemia: Characteristics in Biology, Patients and Treatment. Recommendations of the Working Group Geriatric Oncology of the German Society for Haematology and Oncology (DGHO), the Austrian Society for Haematology and Oncology (ÖGHO) and the German Society for Geriatrics (DGG)

Wedding¹,

Bokemeyer

Meran

2004

Oncol Res Treat

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While the incidence rate of acute myeloid leukaemia (AML) is increasing with the age of the patients, the 5-year-survival rates are decreasing in an age-dependent manner. Patients with AML are considered to be old when they have reached the age of 60. This consideration is due to patient- and disease-specific parameters, which reveal differences between older and younger patients with AML. Standard of therapy is a dose-intensive chemotherapy aiming at the induction of complete remission, followed by different kinds of post-remission therapies. A small percentage of patients can be cured by this approach. However, most patients will die within the first 2 years after diagnosis due to resistance or relapse of the disease or therapy-related complications. The improvements achieved in the treatment of patients with AML are mainly restricted to the group of younger patients. The small percentage of patients who are cured, and the high rate of treatment-related mortality in elderly patients with AML give rise to the question which patients benefit from a primarily curative approach, and which should be treated with a palliative approach. The value of a palliative approach has not yet been consistently assessed in clinical trials. Geriatric assessment will be an important tool in clinical trials for elderly patients with AML to be used in the decision making process. There is hope that new classes of drugs and treatment modalities such as inhibitors of signal transduction, monoclonal antibodies, inhibitors of angiogenesis, or allogenic blood stem cell therapy after non-myeloablative conditioning regimens will improve the therapy of elderly patients with AML in the near future.

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“…the tests Tinetti I and II), and an orientating screening for depression. It can be conducted within 15-20 minutes (for further information, see [11,12]). Using a CGA, the heterogenous population of elderly patients can be subdivided into three groups (table 1): functionally independent patients, patients with some functional dependence, and frail patients [13].…”

Section: Geriatric Assessmentmentioning

confidence: 99%

Chemotherapy in Elderly Patients with Advanced Lung Cancer. Part I: General Aspects and Treatment of Small Cell Lung Cancer (SCLC)

Honecker¹,

Wedding²,

Bokemeyer³

2004

Oncol Res Treat

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There is much uncertainty whether chemotherapy is beneficial for elderly patients with advanced lung cancer. Whereas age alone is not an adverse prognostic factor, decline of physiological function and comorbidity can result in higher rates of treatment-related toxicity, in particular myelosuppression. The higher incidence of comorbid conditions, frequently sharing the risk profile of the malignancy, can translate into worse survival. Therefore, a geriatric assessment of the patient’s overall situation should guide decisionmaking. Mainstay of treatment of small cell lung cancer (SCLC), also in the elderly, is combination therapy. Several retrospective analyses reveal that in elderly patients often lower drug doses are delivered. However, the treatment outcome of these patients does not appear to be worse compared to younger patients. For functionally independent elderly patients, combination chemotherapy with carboplatin and etoposide, supported by optimized supportive care, possibly including hematopoietic growth factors (G-CSF) to minimize toxicity, should be considered. Special attention to renal function should be given and individualized drug dosing, adapted to the glomerular filtration rate, is mandatory. For patients with some functional dependence or showing a certain degree of comorbidity, preliminary data indicate that single-agent therapy with carboplatin can confer the same benefit as combination chemotherapy, but with reduced toxicity. Single agent oral etoposide, however, seems to be inferior to combination treatment and should not be given routinely in the treatment of this cohort. Further evaluation of these topics is needed, and can be achieved by trials specifically designed for elderly patients or patients with reduced performance status.

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Comprehensive Geriatric Assessment in the Elderly Cancer Patient

Cited by 40 publications

References 46 publications

Modern Treatment Options for Elderly Patients with Multiple Myeloma

Modern Treatment Options for Elderly Patients with Multiple Myeloma

Chemotherapy in Elderly Patients with Advanced Lung Cancer. Part I: General Aspects and Treatment of Small Cell Lung Cancer (SCLC)

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