Geriatric Oncology (eBook)

Preface 5
Contents 7
Contributors 9
Aging and Cancer: What Oncologists Need to Know 11
Physiologic Changes with Aging: Practical Considerations in Prescribing Cancer Therapy in Older Adults 12
Domains Other Than Chronological Age That Affect Life Expectancy and Treatment Tolerance 14
Aging and Functional Decline 14
ADLs and IADLs 14
Age and Comorbidity 15
The Role of Comorbidity in Treatment and Prognosis 15
Comorbidity Scales 16
Aging and Changes in Social Support 16
The Role of Social Support After Therapy 17
Aging and Psychological State 17
Aging and Cognitive Decline 18
Cognitive Status Related to Treatment Choices 19
Understanding Treatment Goals 19
Conclusions 20
References 20
Assessing the Older Cancer Patient 26
Introduction 26
Comprehensive Geriatric Assessment 27
Who to Screen? 30
Screening 30
Evaluate Comorbidities 34
Evaluate the Patient’s Functional Status 37
Evaluate Geriatric Syndromes 38
Cognitive Syndromes (Dementia and Delirium) 38
Depression 40
Falls Risk: Assess Gait and Balance Impairment 40
Vision Impairment 41
Hearing Impairment 42
Nutritional Status 43
Incontinence 44
Sleep Disorders 44
Assess Social Issues 45
Living Conditions 45
Caregiver Support 46
Religion 46
Strategy 47
Conclusion 47
References 48
Cancer Screening in Older Adults 55
Introduction 55
Estimates of Life Expectancy 56
Benefits and Harms of Common Cancer Screening Tests 58
Colorectal Cancer Screening 58
Breast Cancer Screening 66
Cervical Cancer Screening 69
Prostate Cancer Screening 71
Integrate Patient Values and Preferences 73
References 74
Physiological Consequences of Aging 79
Physiological Changes with Age (Table 1) 80
Cardiovascular System 80
Renal Function 80
Gastrointestinal Function 83
Cognition 83
Musculoskeletal System 83
Endocrine Function 85
Hematopoietic and Immune Function 86
Inflammation, Coagulation, and Aging 87
Frailty 89
Inflammatory Cytokines and Cancer 89
Summary 90
References 91
Assessment and Impact of Comorbidity in Older Adults with Cancer 102
Assessment of Comorbidity 102
The Charlson Comorbidity Index 103
The Cumulative Illness Rating Scale 104
The Index of Coexistent Diseases 105
The Kaplan-Feinstein Index 106
The Adult Comorbidity Evaluation 27 Index 106
The Sorror Index 107
Indexes Used in Epidemiologic Databases 107
Impact of Comorbidity 108
Comorbidity and Treatment Decisions 108
Comorbidity and Cancer Prognosis 109
General Comorbidity 109
Diabetes 110
Obesity 111
Rheumatoid Arthritis 111
Depression 112
Comorbidity and Treatment Tolerance 112
Conclusion 112
References 113
Geriatric Syndromes Defined and Explained for Oncology Practice 119
Introduction 119
What Is a Geriatric Syndrome? 120
Waiting to Exhale: Anticipating Geriatric Syndromes 123
Weight Loss, Cancer Cachexia, and Sarcopenia of Aging Are Not the Same Thing, but Does It Matter? 124
Falls, Function, and Fractures 128
Delirium, Dementia, and Decisional Capacity 130
Polypharmacy: The Good, the Bad, and the Ugly 131
Summary 135
References 136
Family Caregivers 141
Introduction 141
Family Caregivers 142
Impact of Cancer on Family Caregivers 144
Factors Contributing to Caregiver Burden 144
Benefits of Caregiving 146
Burdens of Family Caregiving 147
Strategies to Strengthen Benefits and Decrease Burdens of Caregivers 153
Self-Care for Cancer Caregivers 154
Summary 155
References 156
Surgical Management of the Older Patient with Cancer 162
Introduction 162
Preoperative Assessment 165
Breast Cancer 168
Colorectal Cancer 173
Liver Metastasis for Colorectal Cancer 178
Hepatocellular Cancer 180
Pancreatic Cancer 181
Gastric Cancer 185
Melanoma 189
Esophageal Cancer 193
Conclusions 194
References 195
Chemotherapy for the Older Adult with Cancer 206
Introduction 206
Pharmacology of Cancer Therapies in Older Adults 208
A Systems-Based Focus on Age-Related Physiologic Effects in Older Cancer Patients 213
Endocrine System 213
Neurological System 217
Immune System and Homeostasis 218
Cardiovascular System 221
Pulmonary System 222
Musculoskeletal Systems 223
Gastrointestinal System 225
Renal System 227
Clinical Pharmacology of Common Cancer Therapies in the Elderly 234
Anthracyclines 234
Platinum Compounds 236
Topoisomerase Inhibitors 237
Antimetabolites 239
Antifolate 239
Cytidine Analogs 240
Fluoropyrimidines 241
Taxanes 243
Vinca Alkaloids 245
Alkylating Agents 245
Complications of Cancer Treatment and Approaches to Supportive Care in Older Persons 246
Conclusion 248
References 249
Radiation Therapy in Geriatric Oncology 267
Prostate 268
Breast 273
Lung 277
Gastrointestinal 281
Summary 288
References 289
Palliative Care: Special Considerations for Older Adults with Cancer 296
Palliative Care-What Is It? 297
Forms of Palliative Care 297
A Palliative Approach 298
Specialist Palliative Care 298
End-of-Life or Terminal Care 298
Role of Palliative Care in Geriatric Oncology 299
Factors Unique to the Care of the Dying Elderly Cancer Patient 299
Physical Factors 300
Psychological Factors 303
Depression 304
Anxiety 305
Delirium and Dementia 306
Social Factors 308
Existential/Spiritual Factors 309
Societal Factors 311
Strategies 312
Summary 316
References 317
Subject Index 328