Hematopoietic growth factors in the older cancer patient

Abstract

Aging is associated with a progressive decline in the functional reserve of multiple organ systems, which may lead to enhanced susceptibility to stress such as that caused by cancer chemotherapy. Myelodepression is the most common and the most commonly fatal complication of antineoplastic drug therapy and may represent a serious hindrance to the management of cancer in older individuals. This is already a common and pervasive problem and promises to become more so. Currently 60% of all neoplasms occur in persons aged 65 years and older, and this percentage is expected to increase as the population ages. This well-known phenomenon, sometimes referred to as squaring or the age pyramid, is caused by the combination of an increasing life expectancy and a decreasing birth rate. This article explores the use of hematopoietic growth factors in the older cancer patient after reviewing the influence of age on hemopoiesis and chemotherapy-related complications. The issue is examined in terms of effectiveness and cost. An outline of the assessment of the older cancer patient is provided at the end of the chapter as a frame of reference for clinical decisions.

Efficacy and safety of lipegfilgrastim compared with placebo in patients with non-small cell lung cancer receiving chemotherapy: post hoc analysis of elderly versus younger patients

“…An estimated 60 % of all malignancies occur in patients >65 years of age, and the number of elderly patients with cancer will increase as life expectancy increases and the population ages [1,2]. In the USA, a 67 % increase in the incidence of all cancers is anticipated for older adults (≥65 years of age), and the percentage of all cancers diagnosed in elderly adults is expected to increase from 61 to 70 % by the year 2030 [3].…”

“…Neutropenia presents an increased risk of serious or life-threatening infections and is a major dose-limiting toxicity for many chemotherapy regimens [4]. Patients aged >65 years are likely to have more comorbidities and take more medications than younger patients, placing them at greater risk than younger patients for developing myelosuppression and neutropenia, the duration of which may reduce survival [1]. Elderly patients are also at increased risk for infections in the presence or absence of neutropenia [2].…”

Temporal and Geographic Variation in the Use of Hematopoietic Growth Factors in Older Women Receiving Breast Cancer Chemotherapy: Findings From a Large Population-Based Cohort

“…1,3 More recently, hematopoietic growth factors have played a major role in preventing infection in cancer patients and shortening the duration of neutropenia in patients receiving chemotherapy. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] As a result, patients can better tolerate the standard chemotherapy regimens and may be able to tolerate the higher doses of chemotherapeutic agents, thereby improving therapeutic outcomes. 3,[9][10][11] During the last decade, numerous clinical trials and meta-analyses have demonstrated the efficacy of colony-stimulating factors (CSFs) in reducing neutropenia and shortening duration of hospitalization among patients with various cancers and all age groups.…”

Prises en charge oncogériatrique du cancer du sein

“…Un score de fragilité pathologique (The Groningen Frailty Indicator ≥ 4) augmente la probabilité de décès au cours du traitement [37]. L'anémie est un facteur de risque indépendant de mauvaise tolérance hématologique [38]. L'altération de la fonction rénale [39] et l'hypoalbuminémie peuvent nécessi-ter des adaptations posologiques.…”