Perspectives on Quality of Life of Older Patients with Cancer

Abstract

Cancer in older people is an increasingly common problem. Since survival benefits may decline and the risks of treatment progressively increase with age, preservation and improvement of quality of life (QOL) is a major goal of geriatric oncology. The concept of health-related QOL holds that the preservation of health and physical function is necessary to the maintenance and improvement of QOL, and encompasses several constructs, including physical, functional, emotional, social, and spiritual domains. Several instruments for the assessment of QOL have been validated, but none has been calibrated to the special problems of older people. Such problems involve diverse evolution of health and disease around variable models, potential age-related shifts in values and focus, and barriers to the use of questionnaires, such as poor visual and auditory function, easy fatiguability, slower reactions and dementia. Individualised questionnaires may represent the ultimate goal in the assessment of QOL in the elderly. The assessment of QOL in general oncology has provided new and important information related to the value of breast preservation in the management of breast cancer, to the value of sexual function in the management of prostate cancer, and to the effects of limb amputation on QOL. Also, QOL at the beginning of treatment has independent prognostic implications. In geriatric oncology, assessment of QOL may allow trade-off between QOL and survival, and may determine the choice among alternative forms of life-prolonging and palliative treatments.

Comprehensive Geriatric Assessment in the Elderly Cancer Patient

“…Therefore routine use outside studies appears not to be useful as the value of the information gained remains to be determined. However, QoL assessment is helpful in sensitizing physicians for patient problems [46][47][48].…”

Physical and psychosocial outcomes in cancer patients: a comparison of different age groups

“…A number of studies have revealed age effects in the selection of screening evaluations and treatment procedures in various cancer samples (Guadagnoli et al, 1990; Liberati et al, 1991;Bennet et al, 1991). For the elderly, co-morbidity, shortened life expectancy and limitations in physical functioning are important considerations in medical decision making (Balducci, 1994). Treatment bias related to age has been reported by several authors (Greenfield et al, 1987;Grover et al, 1989;Silliman et al, 1989).…”

“…Studies have confirmed that advancing age is associated with functional disabilities, dependence in activities of daily living (ADL), and greater co-morbidity (Goodwin et al, 1991;Lauria, 1991;Balducci, 1994). Other investigators reported no significant relationship between age and functional status (Vinokur et al, 1990;Ganz et al, 1992;Given et al, 1994).…”

El paciente oncológico geriátrico

“…El dolor es el síntoma más frecuente y más temido en los pacientes ancianos con cáncer avanzado, al igual que para la población general. Puede producir por si mismo ansiedad, depresión, insomnio, astenia, anorexia, agitación y cambio en el estado mental; algunos factores, como el cansancio y la falta de sueño disminuyen el umbral del dolor, mientras que otros, como el dormir bien, la comprensión por parte de su entorno, la mejora del humor, las distracciones y el conocimiento de su situación, elevan dicho umbral [27][28][29] .…”