Management of Cancer in the Older Patient

Cover......Page 1
ISBN:   9781437713985......Page 2
Copyright......Page 3
Dedication......Page 4
Contributors......Page 8
Preface......Page 12
Acknowledgments......Page 13
Incidence and Mortality: Then and Now......Page 16
Characteristics of Older Patients with Cancer......Page 23
Unique Issues of Cancer and Aging......Page 26
Challenges of Epidemiological Study of Older Patients with Cancer......Page 28
Suggested Readings......Page 30
Analytic Framework: Rejecting Intuitive Thinking in Screening and Prevention......Page 32
Biases in Screening and Prevention Studies......Page 33
Unique Aspects in Judging Benefits and Harms of Cancer Prevention in the Elderly......Page 35
The Wife: Breast Cancer Screening.The wife remains concerned that she has not been getting regular mammograms. There have been a.........Page 36
Husband and Wife: Colorectal Cancer Screening.Until recently, only the home based fecal occult blood test (FOBT) had randomized,.........Page 37
The Husband: Prostate Cancer Prevention......Page 38
The Wife: Breast Cancer Prevention.In the Breast Cancer Prevention Trial (BCPT), 13,388 women at increased risk of breast cancer.........Page 39
Husband and Wife: Colorectal Cancer Prevention.On the basis of the fact that colorectal cancers overexpress cyclooxygenase-2 (CO.........Page 40
Summary......Page 41
Major Imaging Modalities in Cancer Diagnosis......Page 44
Magnetic Resonance Imaging......Page 45
Cancer Pathology......Page 46
Immunohistochemistry......Page 47
Clinical Applications for Biomarkers in Cancer......Page 48
Screening and Early Detection......Page 49
Tumor Markers in Cancer Diagnosis......Page 50
Suggested Readings......Page 51
Functional Status......Page 52
Use of Self-Reported Functional Status Measures in Cancer Patients......Page 53
Get-up-and-Go Test.Ambulation is an essential prerequisite for completing many of the activities of daily living and slowing of .........Page 55
Comorbidity......Page 56
Estimating Life Expectancy by Age and Comorbid Conditions......Page 57
Affect (Affective Assessment)......Page 58
Caregiver Burden......Page 59
Advanced Care Planning......Page 60
A Strategic Approach to Assessment in the Older Patient with Cancer......Page 61
Suggested Readings......Page 63
Academic versus Community Setting......Page 64
Denial/ Need for More Information......Page 65
The Role of Case Conferences and Tumor Boards......Page 66
Breast Cancer......Page 70
Colon Cancer......Page 72
Gastric Cancer......Page 73
Pancreatic Cancer......Page 74
Melanoma......Page 75
Suggested Readings......Page 76
Mechanisms, Rationale, and Process of Care for Radiation Therapy......Page 78
Acute Effects and the Suitability of ­Radiation Therapy in Treatment of the Elderly......Page 80
Late Effects......Page 81
Improved Targeting......Page 82
IMRT......Page 83
Brachytherapy......Page 84
Glioblastoma......Page 86
Non-Small Cell Lung Cancer......Page 87
Pancreatic Cancer.The median age of diagnosis for pancreatic cancer in the United States is 72, and 42% of all patients diagnose.........Page 88
Palliative Radiation......Page 89
Conclusion......Page 90
Tumor Characteristics......Page 92
Therapy Characteristics......Page 93
Hormone Receptor Status.The expression of estrogen and progesterone receptors on the surface of breast cancer cells is both prog.........Page 94
Chemotherapy.The National Comprehensive Cancer Network (NCCN) recommends adjuvant chemotherapy for all patients less than 70 yea.........Page 95
MammaPrint.The MammaPrint assay uses gene expression array technology on 70 genes to classify tumors as either good or poor prog.........Page 96
Pathologic Stage.Colorectal cancers may spread by direct extension, or by hematogenous, or lymphatic routes.81 Hematogenous diss.........Page 97
Summary......Page 98
Molecular Markers.A mutation of the epidermal growth factor receptor (EGFR) to a constitutively active form is an important pred.........Page 99
Decision Aids......Page 100
Suggested Readings......Page 101
Discussion of Case 1......Page 102
Discussion of Case 2......Page 104
Discussion of Case 3......Page 105
Discussion of Case 5......Page 106
Suggested Readings......Page 107
Renal Function......Page 108
Nonadherence......Page 109
Tamoxifen.Tamoxifen is a SERM that competes with estrogen for binding at the estrogen receptor. When used for 5 years in patient.........Page 110
Cetuximab and Panitumumab.Cetuximab is a chimeric monoclonal antibody directed to the exodomain of the epidermal growth factor r.........Page 111
Erlotinib.Erlotinib targets the tyrosine kinase domain of the epidermal growth factor receptor (EGFR). Rare but serious events s.........Page 112
Summary......Page 113
Major Issues in Clinical Trial Development for Older Patients......Page 116
Eligibility Criteria......Page 117
Translational Research......Page 118
Opportunities for Research......Page 119
Summary......Page 120
Communication Barriers in the Elderly......Page 122
Physician Communication......Page 123
Decision making in Older Cancer Patients......Page 124
Suggested Readings......Page 125
13 - Chemotherapy-Induced ­Myelosuppression in the Elderly......Page 128
Benefit to Older Patients from Chemotherapy......Page 129
Myelosuppression in Breast Cancer Patients......Page 130
Consequences of Myelosuppressive Toxicity......Page 131
Modification of Chemotherapy to Reduce Toxicity......Page 132
Changes in the Gastrointestinal System......Page 133
Physiological versus Chronological Age......Page 134
Role of Granulocyte-Stimulating Growth Factors......Page 135
Management of Chemotherapy-Induced Anemia......Page 136
Suggested Readings......Page 137
LHRH Analogs......Page 140
Aromatase Inhibitors......Page 141
Neuropathy.Peripheral neuropathy is a common complication of alkaloids, epipodophyllotoxins, taxanes, epothilones, cisplatin, an.........Page 142
Secondary Leukemia and Myelodysplastic ­Syndrome.Chemotherapy related acute myeloid leukemia (AML) and myelodysplastic syndromes.........Page 143
A Look at the Future......Page 144
Suggested Readings......Page 145
Overview......Page 146
Screening and Diagnosis of Depressive Disorders in Geriatric Oncology......Page 148
Differential Diagnosis of Depression in the Older Patient with Cancer......Page 149
Screening and Assessment Tools......Page 151
Complications of Depression......Page 152
Psychotherapy......Page 154
Pharmacologic Options......Page 155
Monitoring Patients during Depression Management......Page 159
Differential Diagnosis of Anxiety......Page 160
Treatment of Anxiety in the Older Cancer Patient......Page 161
Pharmacological Management......Page 162
Suggested Readings......Page 164
Physiology of Cancer Pain......Page 166
Pain Assessment in Those with Cognitive Impairment......Page 167
Management of Cancer Pain......Page 168
Analgesic Drugs for Cancer Pain......Page 169
Opioid Analgesic Medications......Page 170
Other Nonopioid Medications for Pain......Page 172
Nondrug Strategies for Pain Management......Page 175
Suggested Readings......Page 176
Cancer-Related Fatigue Across the Domains of Quality of Life......Page 178
Pharmacologic......Page 180
Nonpharmacologic......Page 181
Research in CRF Management......Page 182
Suggested Readings......Page 183
Pathophysiology of Nausea and Vomiting......Page 184
Emetogenicity of Chemotherapeutic agents......Page 185
First-Generation 5-HT3 Receptor Antagonists......Page 186
A Second-Generation 5-HT3 Receptor Antagonist (Palonosetron)......Page 187
Atypical Antipsychotics.Olanzapine is a new atypical antipsychotic drug which blocks dopaminergic, serotoninergic, antihistamini.........Page 188
Treatment Recommendations General ­Principles Regarding Emesis Control in Patients Receiving Chemotherapy......Page 189
Acute CINV......Page 190
Acute CINV......Page 191
Management of Breakthrough Emesis......Page 192
Management of Nausea and Vomiting in Patients with Advanced Cancer......Page 193
Suggested Readings......Page 194
Insomnia Prevalence in the General ­Population......Page 196
Insomnia Comorbidities......Page 197
Insomnia and Cancer Survivorship......Page 198
Insomnia and Aging......Page 199
Diagnosis and Evaluation......Page 200
Treatment......Page 201
Insomnia and Mortality......Page 202
Suggested Readings......Page 203
20 - Nutritional Support for the Older Cancer Patient......Page 204
Other Measures......Page 205
Cannabinoids.Cannabinoids have been reported to stimulate appetite. There are a variety of cannabinoids (single-extract and whol.........Page 206
Nutritional Support of Advanced Cancer......Page 207
Why Doctors Need to Ask......Page 208
Complementary, Alternative, and Integrative: What’s in a Name?......Page 209
Botanicals and Nutritional Supplements......Page 210
Cancer-Related Problems and CAM Interventions......Page 211
Nausea and Cachexia......Page 212
Fatigue......Page 213
Hot Flashes......Page 214
Pain......Page 215
Lifestyle Changes and Cancer Survival......Page 216
Suggested Readings......Page 217
Rehabilitation Needs of the Older Patient with Cancer......Page 220
Cancer-Specific Rehabilitation Issues......Page 221
Colorectal Cancer......Page 222
Lung Cancer......Page 223
Where Rehabilitation Can Occur......Page 224
Suggested Readings......Page 225
General Principles of Surveillance......Page 226
Surveillance for Cancer Recurrence.Recommendations for surveillance for recurrence among breast cancer survivors are mainly base.........Page 227
Late Medical and Psychosocial Effects in the Elderly.Fortunately, advances in surgical treatment have reduced the number of brea.........Page 228
Prostate Cancer......Page 229
Late Medical and Psychosocial Effects in the Elderly.Long-term colorectal cancer survivors do not differ from healthy controls i.........Page 230
Review of Introductory Cases......Page 231
Definition of Cancer Survivor......Page 234
Late Effects of Cancer Treatment......Page 235
Contents of Treatment Summary and Survivorship Care Plan......Page 237
Who Prepares the Care Plan?......Page 238
Access and Implementation of Care Plan......Page 239
Suggested Readings......Page 240
Factors Involved in Nonadherence......Page 244
Solutions to the Problem......Page 245
Health Care Providers’ Role......Page 246
Homecare Services......Page 247
Home Safety Evaluation......Page 248
Long-Term Care Options for the Older Adult......Page 249
Definition of Burden......Page 254
Direct-Care Tasks......Page 255
Caregiver Health Conditions......Page 256
Caregiver Traits......Page 257
Role of Primary Care Provider.With appropriate information and support in place, primary care physicians107 appear willing to as.........Page 258
Interventions to Support Caregivers......Page 259
Home Health Care Interventions and Care Coordination......Page 260
Suggested Readings......Page 261
Workup......Page 262
Diagnosis and Referral......Page 263
Treatment......Page 264
Toxicities......Page 265
Follow-up/Surveillance......Page 266
Palliative Care and Hospice......Page 268
Epidemiology......Page 269
Advance Directives......Page 270
Pain......Page 272
Constipation......Page 273
Dyspnea......Page 274
Depression......Page 276
Anxiety and Agitation......Page 277
Delirium......Page 278
Improving End of Life Care for Older Cancer Patients......Page 279
Conclusion......Page 280
29 - Ethical Issues Related to Assessing Decision Making Capacity......Page 282
The Patient Does Not Have Capacity. What Next?......Page 285
Planning for Incapacity......Page 286
Suggested Readings......Page 287
30 - Economic Burdens and Access to Care Barriers for the Older Cancer Patient......Page 288
Medicaid......Page 289
Total and Out-of-Pocket Health Expenditures......Page 290
Access To Care and Quality of Care......Page 291
Suggested Readings......Page 292
B......Page 294
C......Page 295
E......Page 297
H......Page 298
M......Page 299
O......Page 300
P......Page 301
S......Page 302
T......Page 303
Z......Page 304