The older cancer survivor

Medical issues in cancer survivors--a review

Cancer survivorship is an emerging area of scientific and clinical interest. Several decades ago, most people diagnosed with cancer did not live long beyond their initial diagnosis. Today the number of cancer survivors exceeds ten million, and this group may experience unique healthcare issues related to their cancer treatment. Chemotherapy, surgery, and radiation therapy each have their own late and long-term complications. It is imperative for clinicians who are caring for cancer survivors to be aware of long-term complications of therapy and to treat these appropriately. When cancer therapy has successfully added years of life, it is equally as important that medical care assures the best quality of life during those years.

Frail old patients as a target population for cancer trials

The recent distinction between co-morbidity and multi-morbidity well stresses the difficulty of managing old patients with cancer whose complexity is not captured by a list of diagnoses or biological burden alone. The most adequate answer found by oncologists and geriatricians was to work together for better evaluating the physiological age and body reserve of the patient. The gold standard tool to assess old patient with cancer is named Comprehensive Geriatric Assessment. Its systematic application needs geriatric competences and time. In this context, a great number of cancer patients are considered as "frail" because they have reduced available physiological reserves. They might not withstand stress when challenged. Oncologists and geriatricians have imagined an innovative process to change the screening procedure of these patients, determine the prognosis, adapt the treatment strategy, to increase the patient's survival and his/her quality of life. The internet website "www.clinicaltrials.com" only lists 8 studies focused on frail elders with cancer. Six of them are focused on specific cancers or specific treatments, one was applied to all kind of cancers and the last was an opinion overview from oncologists and geriatricians. The selection criteria of frail patients are very diverse and probably include cancer patients who are not comparable. It is now time to try to identify new practical, reliable and accurate tools to facilitate the inclusion of the same kind of patients suffering from the same kind of cancer to be able to give more appropriate care and at the same time to constitute a valuable data base. Existing tools are reviewed and analyzed.

Quality of life and patient-reported outcomes in the older breast cancer patient

As the world population ages, the incidence of cancer will probably also increase as it is a disease predominantly affecting older people. However, those aged 70 years or more have largely been excluded from clinical trials. This review focuses on breast cancer. Increasingly there is recognition that many older breast cancer patients are being undertreated and could and should be offered the same treatments as younger patients. Comprehensive assessment of the quality of any survival benefit from treatments is also needed to ensure that in the future older patients can make fully informed decisions about their treatment options. The aim of this overview is two-fold: first to describe methods by which to assess quality of life; and second to review the recent surgical, radiotherapy, chemotherapy and other studies that include such assessment with older breast cancer patients. Current studies are also outlined, including quality of life assessments, and recommendations are made for future research in this area.

Cancer, comorbidities, and health-related quality of life of older adults

This study examined the physical and mental health of 126,685 males and females age 65 or over, with and without cancer that completed a Medicare Health Outcomes Survey (MHOS) between 1998-2002. Cancer information was ascertained through the National Cancer Institute's (NCI's) Surveillance, Epidemiology and End Results (SEER) program and linked to MHOS data. Results indicated that across most cancer types, cancer patients reported significantly more comorbid conditions and poorer physical and mental health compared with patients without cancer. Negative associations were most pronounced in those with two or more comorbidities and in those diagnosed with cancer within the past year.

Fatigue and functional dependence in older cancer patients

OBJECTIVES

Functional dependence is a costly manifestation of aging that compromises the quality of life of elderly individuals and their caregivers. In this study, we hypothesized that fatigue may be a cause of functional dependence in older cancer patients. To establish whether fatigue was associated with dependence in 1 or more activities of daily living (ADLs) or instrumental activities of daily living (IADLs), and declining performance status (PS). In addition, we studied the prevalence of fatigue and its correlation with anemia, depression, and nutritional status.

MATERIALS AND METHODS

Retrospective cross-sectional study of 214 patients aged 70 and older were seen over a 3-month period by the Senior Adult Oncology Program of the H. Lee Moffitt Cancer Center in Tampa, FL. Each patient was screened with a questionnaire assessing ADLs, IADLs, PS, cognitive impairment, depression, and malnutrition. In addition, each patient underwent assessment of fatigue with the fatigue symptom inventory and a determination of complete blood counts and complete chemical panel.

RESULTS

Fatigue was reported by 81% of the patients. The interference score of fatigue seemed to be a mediator for dependencies in ADLs and IADLs (P < 0.001 and 0.001), and poorer PS (P < 0.001).

CONCLUSIONS

Fatigue is a common chronic problem for older cancer patients and may represent a major cause of functional dependence.

Clinical analysis of multiple primary malignancies in the elderly

BACKGROUND

Cancer incidence raises progressively during life span; it is estimated that by the year 2030 almost 70% of all neoplasms will occur in people over 65 years old. As carcinogenesis is a multistep, time-requiring process, it is expected that as people live longer they are more likely to develop cancer, and therefore, the prevalence of multiple primary malignancies (MPM) is destined to increase with age.

PATIENTS AND METHODS

Records of all consecutive cancer patients referred to our center from January 2004 to January 2007 were reviewed. We chose the definition of MPM proposed by Warren and Gates. Multiple malignancies were assessed for elderly (>or=70 years old) and younger patients. t-Test and Mc Nemar test were used; subgroup analysis was also performed according to age stratification.

RESULTS

A total of 1,503 consecutive patients were considered; 566 were 70 years old or more (mean age 76.5 years, range 70-96 years) and 878 were younger (mean age 57 years, range 18-69 years). The prevalence of multiple malignancies in the elderly people versus younger ones was 15% and 6%, respectively (P = 0.001). As far as the elderly population is concerned, 21% (56/271) of males compared with 14% (42/295) of females had developed MPM; no significant difference was found between the subgroups with MPM or not as far as age (P = 0.16), comorbidities (P = 0.79), medications (P = 0.76), CIRS-G score and index (P = 0.47, P = 0.54), and PS (P = 0.93) are concerned. Most frequent associations among cancer types were prostate with lung (10/87, 11%), prostate with colorectal cancer (10/87, 11%), and smoking-related cancer, namely lung and head and neck cancer (X/Y, 6%).

CONCLUSIONS

Elderly patients are more likely to develop MPM compared to younger ones. Significant cancer association according to field cancerogenesis concept was the one of smoking-related cancer; other MPM patterns were apparently a random phenomenon.

Role of comorbidity, symptoms and age in the health of older survivors following treatment for cancer

Men and women aged over 65 years represent 60% of the 10.8 million cancer survivors in the US. The proportion of older cancer survivors will increase significantly with the aging of the population. Unlike younger survivors, the experience of cancer in those diagnosed with cancer as older adults is often superimposed on existing health conditions, which disproportionately affect the elderly population. Understanding the extent to which having cancer contributes to decrements in physical, mental and social function, above and beyond the influence of other chronic health conditions and normative aging, will be critical to the long-term care of older cancer survivors. In this article, we review the extant research on the influence of comorbidity, symptoms and age on the health and functioning of older survivors following treatment for cancer. Future research directions are highlighted, along with several approaches to advancing the field, including the identification of strategies to deliver care to the older population after cancer treatment, changing how we view older adults and consider their health, and, finally, finding systematic approaches to monitor the impact of cancer on older survivors’ health and wellbeing.

Molecularly Targeted Oncology Therapeutics and Prolongation of the QT Interval

Investigation and utilization of molecularly targeted agents has induced a number of drug adverse effects that are not typically associated with conventional chemotherapy. QT interval prolongation, a cardiac toxicity that increases the risk of fatal arrhythmia, is associated with several novel oncology therapies. Classes of molecularly targeted agents with described QT effects include histone deacetylase inhibitors, multitargeted tyrosine kinase inhibitors, vascular disruption agents, farnesyl protein transferase inhibitors, Src/Abl kinase inhibitors, and protein kinase C inhibitors. Concurrently, guidelines for monitoring the QT-prolonging effects of drugs under development have become increasingly rigorous. Although these guidelines apply to anticancer agents, they were not specifically designed for the oncology patient population. This article will review the pathophysiology of QT prolongation, methods of preclinical QT assessment, and current guidelines for QT evaluation in early phase trials. Additionally, molecularly targeted agents with QT effects will be summarized, and mechanisms of addressing this toxicity in the context of oncology drug development will be explored.