Nutrition, Cancer, and Aging: An Annotated Review

Abstract

The interactions of cancer and malnutrition are discussed with the focus on aging. To establish whether the elderly are more likely to develop cancer cachexia and its complications, this review encompasses the pathogenesis of malnutrition in cancer; the age-related alterations of appetite, gastrointestinal function, energy expenditure, and protein turnover; the diagnosis of malnutrition; and the effectiveness of nutritional support in the elderly. Although metabolic and physiologic changes induced by cancer and age appear synergistic in causing cachexia, more frequent complications of malnutrition have not been observed in the geriatric cancer patients. This may be due to only a small proportion of the elderly with cancer being enrolled in clinical studies or to a reduced cachexia-inducing ability of tumors in these patients. A limited number of studies indicate nutritional replenishment is obtainable in malnourished elderly by hyperalimentation. As restoration of the lean body mass may be slower in older patients, early institution of nutritional support is recommended in malnourished elderly or elderly at risk for malnutrition during neoplastic treatment.

An approach to the management of unintentional weight loss in elderly people

“…Weight loss exacerbates the loss of fat-free mass (sarcopenia) associated with aging, 42 which leads to functional decline and fractures. 43,44 Many elderly patients with unintentional weight loss are experiencing concomitant malnutrition 45 and thereby have cachexia. 46 Cachexia is associated with a disproportionate loss of skeletal muscle rather than of body fat and is generally defined as a profound and marked state of constitutional disorder, general ill health and malnutrition.…”

Chemotherapy in elderly patients with advanced non-small cell lung cancer

“…Denutrition is also frequent in elderly patients due to various reasons: dental problems, low income, beginning of dementia [23]. Finally, specific geriatric syndromes (falls, neglect, abuse, dementia) are also underestimated even by the relatives.…”

Advanced non-small cell lung cancer in elderly patients

“…This geriatric assessment comprises several items (table 1) addressing cognition (mini-mental score [26]), daily activities (activity of daily living (ADL), instrumental ADL (IADL) [27]), depression, which is too often underestimated in elderly patients (geriatric depression scale [28]), nutrition [29], physical performance (''get up and go'' test) and geriatric syndromes. The ADL checklist includes everything necessary for self-care (dressing, transferring, feeding, toilet, etc.).…”