Practical Geriatric Oncology

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Part 1 Key principles in geriatric oncology......Page 13
C. Assessment of older adults with cancer: Integrating geriatric principles in oncology care......Page 15
C.1. The role of functional status......Page 16
C.2. Comorbidity......Page 18
C.3. Cognition......Page 19
C.5. Psychological state and social support......Page 20
D.1. Age and organ function......Page 21
D.3. Inflammation, coagulation, and physiologic dysregulation in older adults......Page 22
Endnote......Page 23
References......Page 24
B. General pharmacological issues related to chemotherapy in elderly cancer patients......Page 30
C. Pharmacology and side effects of specific anticancer drugs in elderly individuals......Page 31
C.2. Platinum compounds......Page 32
C.3. Taxanes......Page 34
C.5. Antimetabolites......Page 35
C.6. Antitumor antibiotics......Page 36
E. Practical recommendations......Page 37
F. Future perspectives......Page 38
References......Page 40
A.1. Pharmacology and metabolism......Page 44
B.2. Endometrial carcinoma......Page 45
B.3. Cognitive function......Page 46
D.1. Bone loss......Page 47
D.3. Joint pain and stiffness......Page 48
D.4. Lipid profile and cardiovascular risk......Page 49
E. Conclusions and future directions......Page 50
References......Page 51
B. Physiologic changes with aging......Page 53
B.2. Nonadherence......Page 54
C.3. Aromatase inhibitors......Page 55
D.2. Trastuzumab......Page 56
E.1. Imatinib......Page 57
E.3. Sorafenib and sunitinib......Page 58
F. Conclusions......Page 59
References......Page 60
B. Breast cancer......Page 64
C. Colorectal cancer......Page 65
D. Hepatic, pancreatic, and biliary surgery......Page 67
E. Upper gastrointestinal surgery......Page 68
G. Head and neck cancer surgery......Page 69
H. Conclusions......Page 70
References......Page 71
B. General considerations......Page 75
C.2. Early invasive breast cancer......Page 79
C.4. Radiation dose......Page 81
D.1. Low and intermediate risk......Page 82
Hormone therapy alone versus hormone therapy and radiation......Page 83
E. Lung cancer......Page 84
Dose......Page 85
Concurrent chemoradiotherapy......Page 86
Dose......Page 87
E.3. Small-cell lung carcinoma......Page 88
F. Glioblastoma multiforme......Page 89
G. Non-Hodgkins lymphoma......Page 90
H. Summary......Page 92
References......Page 93
Part 2 Management of solid tumors in older adults......Page 99
B. Approach to management: Weighing risks and benefits......Page 101
C.1. Tumor gene expression analysis......Page 102
E.1. Surgery and risk assessment......Page 104
F. Radiation therapy......Page 105
G.2. Omitting radiation in patients treated with hormonal therapy......Page 106
H.1. Ductal carcinoma in situ......Page 107
I. Early stage......Page 108
I.1. Hormonal therapy......Page 109
I.3. Determinants of increased benefit from chemotherapy......Page 110
J. Tools to assess benefits and toxicity from chemotherapy......Page 111
K. Available chemotherapy regimens......Page 112
L. Metastatic disease......Page 113
M. Choice of chemotherapeutic regimen......Page 114
O. The frail elderly patient......Page 115
References......Page 117
B. Non-small-cell lung cancer (NSCLC)......Page 122
D. Systemic chemotherapy: Monotherapy......Page 123
E. Combination chemotherapy......Page 124
F. Second-line therapy......Page 126
G. Early-stage NSCLC: Surgically resectable patients......Page 127
I. Small-cell lung cancer (SCLC)......Page 128
L. Limited-stage SCLC......Page 129
M. Prophylactic cranial irradiation......Page 130
N. Future perspectives......Page 131
References......Page 132
B. Goals of multimodality treatment......Page 136
D. Etiology and molecular markers......Page 137
E. Combined modality treatment......Page 138
F. Induction chemotherapy......Page 140
H. Locoregional nonmetastatic recurrence......Page 141
K. Conclusion......Page 142
References......Page 144
A.4. Evaluation and staging......Page 147
Primary surgery......Page 148
Preoperative and perioperative chemotherapy......Page 149
A.6. Treatment-metastatic disease......Page 150
B.1. Epidemiology......Page 151
B.4. Evaluation and staging......Page 152
Primary surgery......Page 153
B.6. Treatment-advanced disease......Page 154
B.8. Treatment conclusion......Page 155
References......Page 156
B. Epidemiology of colorectal cancer in the older patient......Page 160
C. Selection of elderly colorectal cancer patients for screening and treatment......Page 162
D. Screening for colorectal cancer in the elderly patient......Page 163
E. Surgery for colorectal cancer in the elderly patient......Page 165
F. Radiotherapy for rectal cancer in the elderly patient......Page 166
G.1. Adjuvant chemotherapy for colorectal cancer......Page 167
G.2. Chemotherapy for metastatic colorectal cancer......Page 171
H. Conclusion......Page 176
References......Page 177
B.1. Superficial bladder cancer......Page 183
Radical cystectomy......Page 185
Bladder preservation......Page 186
B.3. Chemotherapy......Page 187
C.1. Localized kidney cancer......Page 190
C.2. Metastatic kidney cancer......Page 191
References......Page 194
B. Etiology......Page 198
C. Prevention......Page 199
D.1. Screening......Page 200
D.3. Risk stratification......Page 201
F. Localized disease......Page 202
Active surveillance......Page 203
G. Locally advanced disease......Page 205
H.1. Hormonal therapy or androgen-deprivation therapy (ADT)......Page 206
Chemotherapy......Page 209
J. Conclusions......Page 210
References......Page 211
B.2. Diagnosis......Page 213
B.4. Surgery......Page 214
First line......Page 215
Second line......Page 217
B.8. Quality of life and survivorship......Page 218
C. Endometrial cancer......Page 219
C.2. Surgery......Page 220
C.5. Quality of life and survivorship......Page 221
D. Conclusion......Page 222
References......Page 224
Part 3 Management of hematologic malignancies in older adults......Page 231
C. Diagnosis......Page 233
E. Prognosis......Page 234
F.1. Supportive care......Page 236
F.2. Chemotherapy......Page 237
G. Unresolved issues for the aging patient......Page 238
I. Conclusions......Page 239
References......Page 240
A.2. Molecular biology......Page 242
A.5. Imatinib mesylate in chronic phase disease......Page 243
A.7. Resistance and second-generation tyrosine kinase inhibitors......Page 245
A.10. Interferons......Page 246
A.11. Reduced-intensity stem cell transplantation......Page 247
B.2. Diagnosis......Page 248
B.3. Staging and prognosis......Page 249
Initial treatment......Page 250
B.5. Conclusions......Page 251
References......Page 253
B. Host-related factors and biological features of acute myeloid leukemia (AML)
in the elderly......Page 257
C. Decision making and quality of life in elderly AML patients......Page 260
D.3. Standard intensive induction therapy and role of postremission therapy......Page 261
D.5. Role of hematopoietic stem cell transplantation......Page 262
E.1. Novel chemotherapeutic agents......Page 263
E.3. FLT3 inhibitors......Page 264
E.5. Other agents......Page 265
G. Summary and conclusions for future directions......Page 266
References......Page 267
D. The current era: Increased utilization of HCT in older adults......Page 272
F. Transplant tolerability......Page 273
F.3. Donors......Page 274
G.1. Autologous hematopoietic cell transplantation......Page 275
H. Allogeneic hematopoietic cell transplantation......Page 277
I.2. Comorbidity......Page 278
I.4. Biomarkers......Page 279
K. Conclusion......Page 280
References......Page 281
B. Impact of aging......Page 286
C. Epidemiology and classification of non-Hodgkins lymphoma (NHL)
in the elderly......Page 287
F. Therapy of diffuse large B-cell lymphoma in the elderly......Page 288
G. Therapy of follicular lymphoma in the elderly......Page 292
I. Summary......Page 293
References......Page 295
B. Clinical presentation and biology of disease......Page 300
C. Treatment......Page 301
D. Lenalidomide......Page 302
E. Bortezomib......Page 303
F. Stem cell transplantation......Page 304
G. Approach to the care of older adults with myeloma......Page 305
References......Page 306
Part 4 Symptom management and supportive care of older adults......Page 309
C. Older cancer patients in need......Page 311
E. Education......Page 312
G. Exercise......Page 313
I. Multimodality interventions......Page 314
L. Internet cancer support groups......Page 315
M. Supportive-expressive group therapy......Page 316
N. Behavioral activation and problem-solving skills training......Page 317
P. Conclusion......Page 318
References......Page 320
B.1. Linking disease and disability: Implications for cancer care......Page 324
B.3. Prevalence of functional impairment in older cancer patients......Page 325
Prior to initiation of therapy......Page 326
C.1. Comprehensive geriatric assessment......Page 327
C.2. Exercise......Page 328
C.3. Rehabilitation......Page 329
C.5. Nutritional interventions......Page 330
D. Priorities for future research......Page 331
References......Page 332
B.2. Age and the risk of neutropenic complications......Page 335
B.4. Reduced chemotherapy dose intensity......Page 337
C.1. Myeloid growth factor use in older cancer patients......Page 338
D.1. Overview of clinical practice guidelines......Page 339
D.2. Comparison of recent myeloid growth factor guidelines......Page 340
D.3. Recommendations for the myeloid growth factors in the elderly cancer patient......Page 342
E. Clinical decision support for myeloid growth factors......Page 343
F. Economic considerations for the myeloid growth factors......Page 344
G. Safety of the myeloid growth factors......Page 345
H. Conclusions......Page 346
References......Page 347
B. Prevalence and morbidity/mortality associated with anemia in the aged......Page 350
D. Morbidity and mortality of anemia among the geriatric population......Page 351
E. Erythropoietin structure, function, and pharmacology......Page 352
F. Use of erythropoiesis-stimulating agents (ESAs) in cancer- and
chemotherapy-associated anemia......Page 353
G. ESAs and impact on survival in patients with cancer......Page 354
H. Biology of erythropoietin receptors......Page 355
I. Positive ESA clinical studies......Page 356
J. Conclusions......Page 357
References......Page 358
B.1. Depression in patients with cancer......Page 363
B.2. Depression in geriatric patients with cancer......Page 365
B.3. Treatment for depressed patients with cancer......Page 366
C.2. Anxiety in geriatric patients with cancer......Page 368
C.3. Treatment for anxious older patients with cancer......Page 369
D. Summary and conclusion......Page 371
References......Page 372
A. Why focus on the elderly?......Page 374
B. Undertreatment of pain......Page 375
E. It is more than just pain......Page 376
G. Aging physiology: Pain management......Page 377
I.2. Nonsteroidal anti-inflammatory drugs......Page 378
J. Opioids......Page 379
K. Opioid adverse effects......Page 381
L. The future......Page 383
References......Page 384
B. Review of the current evidence......Page 387
C. Practical recommendations for managing fatigue in the elderly......Page 388
Discussion......Page 393
D. The future of fatigue-related research in the elderly......Page 394
E. Conclusion......Page 395
References......Page 396
A. Etiology of dyspnea......Page 398
C. Assessment of dyspnea......Page 399
E. Oral and parenteral opioids......Page 401
G. Psychotropic drugs......Page 402
G.4. Inhaled furosemide......Page 403
K. Breathing techniques......Page 404
N. Global intervention strategies......Page 405
References......Page 408
A. Diarrhea......Page 412
B. Constipation related to cancer therapy......Page 415
C. Cancer treatment–related nausea and vomiting......Page 417
D. Oral mucositis and alimentary tract mucositis......Page 420
E. Neutropenic enterocolitis......Page 423
G. Conclusions......Page 424
References......Page 425
Index......Page 431