Perspectives and limits of cancer treatment in an oldest old population

Abstract

Background Population of oldest old will grow dramatically in the next future and cancer, physiologically related to aging, will be very prevalent among them. Lack of evidence is a huge problem to manage cancer in oldest old and will be more and more in the next years. Aims Our purpose was to investigate the characteristics of a population of oldest old patients with cancer treated in the Radiation Oncology Unit of Fondazione Policlinico A. Gemelli IRCCS. Methods We conducted a retrospective study. The primary outcome was to evaluate which characteristics of the population could influence the choice of oncological treatment (with radical or non-radical intent). Results We identified a total of 348 patients: 140 were on follow-up; 177 were under treatment; 31 were considered not eligible for treatments. Patients under treatment had a high comorbidity index (mean Charlson Comorbidity Index 5.4), and a high prevalence of polypharmacy (mean number of drugs 5.6). More than half (53.1%) was treated with radical intent. Patients treated with radical intent were 1 year younger (87.1 years old vs 88.1 years old), more performant (ECOG 0.7 vs 1.3), and had less prevalence of metastatic neoplasia (6.4% vs 34.9%); comorbidities and drugs did not show differences in the two groups. Conclusion Oldest old, usually not considered in international guidelines, are treated for oncological disease, often with radical intent. The treatment seems not to be tailored considering comorbidities but on performance status.

Characteristics of patients with cancer in European long-term care facilities

“…Also, preventive drugs such as low-dose acetylsalicylic acid and statins are widely prescribed among participants with and without cancer. These findings are similar to those of studies showing that patients with cancer in an acute hospital setting continued to receive preventive medications, and even have preventive medications started near end of life [ 29 , 30 ]. Recent studies have shown that vitamin D supplementation in patients with cancer could have a positive impact [ 31 ].…”

Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer

“…Considering the increased comorbidities, decreased resilience to surgical stress, and vulnerability to poor nutrition of elderly patients, clinicians tend to choose conservative treatment, like chemotherapy, palliative therapy, or even only symptomatic treatment, instead of curative-intent surgery [ 16 ]. In fact, this frequently leads to the undertreatment of this patient population [ 17 ]. Recent studies have revealed that in the context of colorectal cancer, elderly patients derived equivalent oncologic outcomes to younger patients after radical surgery and concluded that age was not an independent prognostic factor for long-term survival [ 18 , 19 ].…”

Octogenarians’ Breast Cancer Is Associated with an Unfavorable Tumor Immune Microenvironment and Worse Disease-Free Survival

“…In clinical practice, octogenarians are more likely to receive nonstandard care or be undertreated [69][70][71] because of their medical comorbidities, frailty, concern for treatment toxicity, or social determinants of health. Often performance status and comorbidities rather than cancer biology dictate the management strategy in elderly patients [72]. About half of early-stage breast cancer patients over 70 years old were reported to have sarcopenia [73].…”