Hurria / Balducci Geriatric Oncology

Treatment, Assessment and Management
1. Auflage 2009
ISBN: 978-0-387-89070-8
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 346 Seiten

Cancer and aging are integrally related. Cancer incidence and mortality increase with age, with most cancer diagnoses and deaths occurring in patients aged 65 and older. The aging of the Baby Boomer population, along with an overall increase in life expectancy, points to a doubling of the U.S. population over age 65 by the year 2030. This demographic shift, combined with the known association of cancer and aging, is expected to bring about a rapid growth in the older cancer-patient population. It is clear that geriatric principles must become part of oncology care. The evaluation and development of treatment recommen- tions for an older adult with cancer can be challenging for many reasons. Tumor biology and response to therapy are affected by age. In addition, age-related factors may impact treatment patterns, tolerance, and efficacy. These age-related factors include functional status declines, comorbid conditions, changes in cognitive function, weakening of organ function, decreases in physiologic reserve, and faltering social support.

Autoren/Hrsg.

Hurria, Arti

Balducci, Lodovico

Inhaltsverzeichnis

1;Preface;5
2;Contents;7
3;Contributors;9
4;Aging and Cancer: What Oncologists Need to Know;11
4.1;Physiologic Changes with Aging: Practical Considerations in Prescribing Cancer Therapy in Older Adults;12
4.2;Domains Other Than Chronological Age That Affect Life Expectancy and Treatment Tolerance;14
4.2.1;Aging and Functional Decline;14
4.2.1.1;ADLs and IADLs;14
4.2.2;Age and Comorbidity;15
4.2.2.1;The Role of Comorbidity in Treatment and Prognosis;15
4.2.2.2;Comorbidity Scales;16
4.2.3;Aging and Changes in Social Support;16
4.2.3.1;The Role of Social Support After Therapy;17
4.2.4;Aging and Psychological State;17
4.2.5;Aging and Cognitive Decline;18
4.2.5.1;Cognitive Status Related to Treatment Choices;19
4.3;Understanding Treatment Goals;19
4.4;Conclusions;20
4.5;References;20
5;Assessing the Older Cancer Patient;26
5.1;Introduction;26
5.2;Comprehensive Geriatric Assessment;27
5.3;Who to Screen?;30
5.4;Screening;30
5.5;Evaluate Comorbidities;34
5.6;Evaluate the Patient’s Functional Status;37
5.7;Evaluate Geriatric Syndromes;38
5.7.1;Cognitive Syndromes (Dementia and Delirium);38
5.7.2;Depression;40
5.7.3;Falls Risk: Assess Gait and Balance Impairment;40
5.7.4;Vision Impairment;41
5.7.5;Hearing Impairment;42
5.7.6;Nutritional Status;43
5.7.7;Incontinence;44
5.7.8;Sleep Disorders;44
5.7.9;Assess Social Issues;45
5.7.9.1;Living Conditions;45
5.7.9.2;Caregiver Support;46
5.7.9.3;Religion;46
5.7.10;Strategy;47
5.8;Conclusion;47
5.9;References;48
6;Cancer Screening in Older Adults;55
6.1;Introduction;55
6.2;Estimates of Life Expectancy;56
6.3;Benefits and Harms of Common Cancer Screening Tests;58
6.3.1;Colorectal Cancer Screening;58
6.3.2;Breast Cancer Screening;66
6.3.3;Cervical Cancer Screening;69
6.3.4;Prostate Cancer Screening;71
6.4;Integrate Patient Values and Preferences;73
6.5;References;74
7;Physiological Consequences of Aging;79
7.1;Physiological Changes with Age (Table 1);80
7.1.1;Cardiovascular System;80
7.1.2;Renal Function;80
7.1.3;Gastrointestinal Function;83
7.1.4;Cognition;83
7.1.5;Musculoskeletal System;83
7.1.6;Endocrine Function;85
7.1.7;Hematopoietic and Immune Function;86
7.2;Inflammation, Coagulation, and Aging;87
7.3;Frailty;89
7.4;Inflammatory Cytokines and Cancer;89
7.5;Summary;90
7.6;References;91
8;Assessment and Impact of Comorbidity in Older Adults with Cancer;102
8.1;Assessment of Comorbidity;102
8.2;The Charlson Comorbidity Index;103
8.3;The Cumulative Illness Rating Scale;104
8.4;The Index of Coexistent Diseases;105
8.5;The Kaplan-Feinstein Index;106
8.6;The Adult Comorbidity Evaluation 27 Index;106
8.7;The Sorror Index;107
8.8;Indexes Used in Epidemiologic Databases;107
8.9;Impact of Comorbidity;108
8.10;Comorbidity and Treatment Decisions;108
8.11;Comorbidity and Cancer Prognosis;109
8.11.1;General Comorbidity;109
8.11.2;Diabetes;110
8.11.3;Obesity;111
8.11.4;Rheumatoid Arthritis;111
8.11.5;Depression;112
8.12;Comorbidity and Treatment Tolerance;112
8.13;Conclusion;112
8.14;References;113
9;Geriatric Syndromes Defined and Explained for Oncology Practice;119
9.1;Introduction;119
9.2;What Is a Geriatric Syndrome?;120
9.3;Waiting to Exhale: Anticipating Geriatric Syndromes;123
9.4;Weight Loss, Cancer Cachexia, and Sarcopenia of Aging Are Not the Same Thing, but Does It Matter?;124
9.5;Falls, Function, and Fractures;128
9.6;Delirium, Dementia, and Decisional Capacity;130
9.7;Polypharmacy: The Good, the Bad, and the Ugly;131
9.8;Summary;135
9.9;References;136
10;Family Caregivers;141
10.1;Introduction;141
10.2;Family Caregivers;142
10.3;Impact of Cancer on Family Caregivers;144
10.4;Factors Contributing to Caregiver Burden;144
10.5;Benefits of Caregiving;146
10.6;Burdens of Family Caregiving;147
10.7;Strategies to Strengthen Benefits and Decrease Burdens of Caregivers;153
10.8;Self-Care for Cancer Caregivers;154
10.9;Summary;155
10.10;References;156
11;Surgical Management of the Older Patient with Cancer;162
11.1;Introduction;162
11.2;Preoperative Assessment;165
11.3;Breast Cancer;168
11.4;Colorectal Cancer;173
11.5;Liver Metastasis for Colorectal Cancer;178
11.6;Hepatocellular Cancer;180
11.7;Pancreatic Cancer;181
11.8;Gastric Cancer;185
11.9;Melanoma;189
11.10;Esophageal Cancer;193
11.11;Conclusions;194
11.12;References;195
12;Chemotherapy for the Older Adult with Cancer;206
12.1;Introduction;206
12.2;Pharmacology of Cancer Therapies in Older Adults;208
12.3;A Systems-Based Focus on Age-Related Physiologic Effects in Older Cancer Patients;213
12.3.1;Endocrine System;213
12.3.2;Neurological System;217
12.3.3;Immune System and Homeostasis;218
12.3.4;Cardiovascular System;221
12.3.5;Pulmonary System;222
12.3.6;Musculoskeletal Systems;223
12.3.7;Gastrointestinal System;225
12.3.8;Renal System;227
12.4;Clinical Pharmacology of Common Cancer Therapies in the Elderly;234
12.4.1;Anthracyclines;234
12.4.2;Platinum Compounds;236
12.4.3;Topoisomerase Inhibitors;237
12.4.4;Antimetabolites;239
12.4.4.1;Antifolate;239
12.4.4.2;Cytidine Analogs;240
12.4.4.3;Fluoropyrimidines;241
12.4.5;Taxanes;243
12.4.6;Vinca Alkaloids;245
12.4.7;Alkylating Agents;245
12.5;Complications of Cancer Treatment and Approaches to Supportive Care in Older Persons;246
12.6;Conclusion;248
12.7;References;249
13;Radiation Therapy in Geriatric Oncology;267
13.1;Prostate;268
13.2;Breast;273
13.3;Lung;277
13.4;Gastrointestinal;281
13.5;Summary;288
13.6;References;289
14;Palliative Care: Special Considerations for Older Adults with Cancer;296
14.1;Palliative Care-What Is It?;297
14.2;Forms of Palliative Care;297
14.2.1;A Palliative Approach;298
14.2.2;Specialist Palliative Care;298
14.2.3;End-of-Life or Terminal Care;298
14.2.4;Role of Palliative Care in Geriatric Oncology;299
14.3;Factors Unique to the Care of the Dying Elderly Cancer Patient;299
14.4;Physical Factors;300
14.5;Psychological Factors;303
14.5.1;Depression;304
14.5.2;Anxiety;305
14.5.3;Delirium and Dementia;306
14.6;Social Factors;308
14.7;Existential/Spiritual Factors;309
14.8;Societal Factors;311
14.9;Strategies;312
14.10;Summary;316
14.11;References;317
15;Subject Index;328