Supportive care of elderly patients with cancer.
The majority of cancers are more prevalent in individuals aged >/= 65 years than in younger patients, and supportive care is the key to treatment tolerance and quality of life for these individuals. This article examines the management of common complications of chemotherapy and pain in older patients with cancer. In accordance with the National Cancer Center Network guidelines, it is recommended that individuals aged >/= 65 years be treated prophylactically with filgrastim or pegfilgrastim for the prevention of neutropenic infections when challenged by chemotherapy of dose intensity comparable to that of CHOP (cyclophosphamide/ doxorubicin/vincristine/prednisone) and that the levels of circulating hemoglobin be kept at >/= 12 g/dL. In addition, it is recommended that the dose of cytotoxic agents be adjusted to renal function and that low-toxicity treatment (ie, capecitabine in lieu of 5-fluorouracil [5-FU], pegylated liposomal doxorubicin in lieu of doxorubicin) be used when feasible and indicated. For the management of pain, the following principles are established: age is not an absolute hindrance to pain assessment; a number of instruments and the observation of pain behaviors are reliable even in patients with dementia; cyclooxygenase (COX)-2 inhibitors are preferable to COX-1 inhibitors for individuals with bleeding diathesis, peptic ulcer, and Helicobacter pylori gastritis; and opioids should be slowly titrated because the effectiveness and toxicity become less predictable with age. In conclusion, with individualized supportive care, the survival and quality of life of older patients with cancer may be improved.
Balducci
Lodovico
L
H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa.