ANTINEOPLASTIC CHEMOTHERAPY OF THE OLDER CANCER PATIENT
Section snippets
Pharmacokinetics
All pharmacokinetic parameters illustrated in Figure 1 are influenced by age. The absorption of drugs and nutrients is progressively reduced by restriction in the absorptive surface of the small bowel and in the splanchnic circulation.23, 29, 43, 58, 89 Lessened gastric motility and gastric secretion may also delay the absorption of drugs.23, 43 Traditionally, changes in absorption have had limited effects on cancer chemotherapy regimens, but they may become more relevant with the development
ASSESSMENT OF THE OLDER CANCER PATIENT
Treatment-related decisions must be tailored to the condition of the individual patient, based on the answers to the following questions:
- 1
Is the patient going to die with cancer or of cancer?
- 2
Is the patient going to suffer cancer-related morbidity during his or her lifetime?
- 3
Is the patient likely to tolerate the complications of treatment?
A comprehensive assessment of the older patient provides a frame of reference to answer these questions5, 6 and can direct treatment-related decisions.
PRACTICAL SUGGESTIONS FOR THE MANAGEMENT OF THE OLDER CANCER PATIENTS WITH CYTOTOXIC CHEMOTHERAPY
A number of practical guidelines and a research agenda for the future may be derived from this discussion.
Practical guidelines for the management of the older cancer patient with cytotoxic chemotherapy include
Pharmacologic interventions
- 1
Adjust initial dose of chemotherapy to the renal function of the patient; subsequent doses should be further adjusted according to the nadir counts and other toxic complications.
- 2
Maintain hemoglobin levels at or above 12 g/dL when possible with the
- 1
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Long-term survival and late toxicities of elderly nasopharyngeal carcinoma (NPC) patients treated by high-total- and fractionated-dose simultaneous modulated accelerated radiotherapy with or without chemotherapy
2019, Oral OncologyCitation Excerpt :The reason for this finding may be that most of the elderly NPC patients already had poor physiologic function and low compensative capacity. When they received chemotherapy, the benefits of chemotherapy might be counteracted by its substantial impact on their normal function with numerous adverse effects [3,10–12]. Patients’ baseline health and function should be considered when considering chemotherapy, and the comparative risks and benefits should be discussed carefully [39].
History of cancer and mortality in community-dwelling older adults
2011, Cancer EpidemiologyThe challenge of treating older patients with pancreaticobiliary malignancies
2018, Current Problems in Cancer
Address reprint requests to Lodovico Balducci, MD, H. Lee Moffitt Cancer Center, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33612–9497