CA: A Cancer Journal for Clinicians, Vol 29, 322-332, Copyright
© 1979 by American Cancer Society
Aging and Cancer Management Part I: Clinical Observations
Bruce A. Peterson M.D.1 and
B. J. Kennedy M.D.2
1 Assistant Professor of Medicine, Section of Medical Oncology, Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis, Minnesota, and American Cancer Society Junior Faculty Clinical Fellow.
2 Professor of Medicine and Director, Section of Medical Oncology, Department of Medicine, University of Minnesota Health Sciences Center, Minneapolis, Minnesota.
It is apparent that the consequences of aging must be considered in the management of elderly patients with cancer. Although strategy will not be modified in most instances because of age, physicians must be able to recognize when the more conservative diagnostic or therapeutic approaches are warranted. Some patients will not benefit from extensive evaluation, surgery or chemotherapy, yet in these individuals, the resources of the health care team still have much to offer. The great majority of elderly patients, however, will profit from comprehensive management, including specific efforts to treat the cancer.
Surgery can be successfully employed in the treatment of cancer, but the surgeon must recognize that there are increased risks associated with its use in the aged. At the Memorial Sloan-Kettering Cancer Center, the operative mortality from all causes was 50 percent higher among patients over 70 years of age than in those under 70 years old. But these results included patients in whom the surgical procedure seemed incidental to their death, and with newer advances in surgical techniques and the physiologic monitoring of patients, operative mortality in cancer patients will be reduced. As long as surgical procedures are well planned and patients are carefully selected, major cancer surgery in the elderly is justified.
Little is known of the toxic effects of chemotherapeutic drugs as they occur specifically in the aged. The ability of hematopoietic cells to recover following myelosuppressive chemotherapy seems to be retained despite aging, but there is less functional bone marrow in an elderly patient. This may occasionally result in unexpectedly profound neutropenia or thrombocytopenia. The use of agents with other potentially adverse effects, such as the impairment of cardiac or pulmonary function, should be monitored closely because some elderly individuals will not tolerate even a minimal reduction in function. Most patients will, however, tolerate full doses when chemotheraphy is used with appropriate caution.
General considerations of health problems other than the cancer frequently influence the management of the aged patient, for these problems may complicate or compromise therapy of the cancer. Also, a nonmalignant disease is sometimes of overriding importance to the health of the individual, and active therapy of the cancer may be comparatively trivial. The appearance of new symptoms in a patient with a past history or present diagnosis of cancer requires full evaluation. The symptoms may signal the occurrence of a different disease, including a new primary cancer, and should not automatically be ascribed to the previous cancer.
Adequate attention must be focused on managing anxiety, pain and nausea, because the successful control of these often constitutes a major achievement in the management of advanced cancer. Although drugs may be extremely beneficial in controlling these symptoms, the possibility of adverse drug interactions should be anticipated and potentially hazardous reactions prevented. Support by the health care team in meeting the patient's emotional and social needs also contributes immeasurably to the alleviation of these problems.
Physicians who care for elderly patients with cancer must exercise informed judgment in planning individual management programs. Careful consideration must be given to the occurrence and behavior of specific cancers in the elderly, and patients' ability to tolerate the rigors of therapeutic intervention. Although the patient's age is an important determinant, decisions cannot be made on that basis alone.
