Combined modality therapy in the elderly population.
The incidence of cancer among older patients continues to rise. The use of combined modality therapy has improved survival in a variety of malignancies, including rectal, head and neck, and lung cancer; however, the addition of chemotherapy increases substantially the toxicities of treatment. Elderly patients have generally been excluded from prospective clinical trials and as such, there is a lack of evidence-based data with regards to the most appropriate treatment. Age itself should not be used as a criterion for foregoing combined modality therapy in elderly patients. Due to the increased toxicity of therapy, patients must be carefully selected. Any medical intervention should account for life expectancy, performance status, tolerance to therapy, and presence of medical or social conditions that may impact therapy. We encourage a comprehensive geriatric assessment to evaluate functional status, comorbidities, mental status, psychological state, social support, nutritional status, polypharmacy, and geriatric conditions in order to improve a patient's overall functional status during the course of therapy. Fit elderly patients should be considered candidates for combined modality therapy, however, because they are potentially more vulnerable to therapy, careful attention should be paid to hydration and nutritional status with early intervention when necessary. Investigators should be encouraged to expand eligibility to include elderly patients on non age-related clinical trials. Additionally, therapy-related clinical trials directed at the elderly should be developed.
Lin
Lilie L
LL
Department of Radiation Oncology, University of Pennsylvania, 3400 Spruce Street, 2 Donner Building, Philadelphia, PA 19104, USA. lin@xrt.upenn.edu
Hahn
Stephen M
SM
D000368:Aged; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods*; D015897:Comorbidity; D015577:Geriatric Assessment; D005853:Geriatrics / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000628:therapy*; D008495:Medical Oncology / Q000379:methods; D009369:Neoplasms; D012004:Rectal Neoplasms / Q000628:therapy*; D016896:Treatment Outcome