Palliative Therapies in Elderly Cancer Patients

Abstract

Palliative therapy in elderly cancer patients deserves special attention because of differences between young and elderly cancer patients. In elderly patients, the treatment produces more adverse effects and the disease is cured less frequently, but the prognosis is usually better than in young patients with cancer. In the elderly population, cancer is seen more frequently than in the young population, yet elderly patients are less frequently included in trials. It is obvious that the results obtained from the treatment of young cancer patients do not necessarily apply to elderly cancer patients. The existing lack of formal data for the management of elderly cancer patients justifies 5 distinctive steps: collection of individual information; review of the available and appropriate knowledge; definition and specification of treatment goals; selection of treatment tools; and assessment of outcome. Following these steps will lead to coordination of oncology and palliative medicine.

Comparison of three instruments (QLQ-C30, SF-36, QWB-7) measuring health-related quality of life/quality of well-being

“…Health-related quality of life (HRQL) is now recognized as an important outcome measure in clinical investigation and patient care (Bruner, 1995;Osoba, 1994;Porzsolt et al, 1995;Tcheckmedyian and Cella, 1990). This is especially the case when treatment is given with palliative intent or involves treatment related morbidity (Osoba, 1994;Porzsolt et al, 1995).…”

“…This is especially the case when treatment is given with palliative intent or involves treatment related morbidity (Osoba, 1994;Porzsolt et al, 1995). The great interest in this topic is demonstrated by the enormous growth rate of articles on HRQL in oncology as well as other fields of medicine (Bruner, 1995;Gill and Feinstein, 1994).…”

Cancer Chemotherapy in the Elderly

“…Cytotoxic agents metabolised by the liver include nitrosoureas, dacarbazine, anthracyclines, mitoxantrone, vinca alkaloids, cytarabine, etoposide, fluorouracil, and taxanes (Table 1). 23 ,z 4 ,z 6 There is little evidence that age itself warrants dose modification of hepatically cleared cytotoxic drugs. 27 Probably more important are interactions of cytotoxic drugs with concomitant medications which may alter hepatic metabolism, such as cimetidine and phenobarbitone.…”

“…1 As a result, the optimum use of chemotherapy in the elderly is not clear. 6 Traditionally, chemotherapy has been withheld or given in reduced doses in older patients because of a perceived increase in pharmacodynamic response. 1 , 7 -9 However, these empirical treatment policies, chosen to reduce toxicity, may be compromising therapy results and creating the fallacious impression that chemotherapy is sometimes less effective in older patients with cancer.…”

When Drug Treatment in the Elderly Is Not Cost Effective

“…[9,13.IS] The issue is not made easier by the fact that there have been fewer trials of drugs conducted in elderly populations, perhaps due to the greater practical difficulty in obtaining informed consent on account of cognitive impairment. [9,13.IS] The issue is not made easier by the fact that there have been fewer trials of drugs conducted in elderly populations, perhaps due to the greater practical difficulty in obtaining informed consent on account of cognitive impairment.…”