The authors have done a major effort in providing in record time chapters that truly reflect the state of the art in the management of senior adults with cancer. Many questions in this advancing field need considerable work before adequate guidelines can be provided. Nevertheless, progress is being made and is reflected by the contributions.
We recognize that some diseases have not been discussed and interesting topics have not been addressed. This gap is filled by more comprehensive books, and today’s electronic communications allow one to explore any area of interest easily.
The treatment of any patient requires a careful evaluation of the person who is in need of such treatment. This is even truer for the seniors, who have less reserves to cope with cancer and its treatment. Therefore, this handbook leaves ample space for chapters that help in the delicate decisionmaking process, which should lead to the best therapy, adapted not only to the disease but also to the person who suffers from it.
Annals of Oncology, the official journal of ESMO, and the soon-to-belaunched Journal of Geriatric Oncology, official journal of SIOG, will keep us updated, as will all major medical journals. We know that this handbook, like any book, will need a second edition soon!
My last words go to Dirk, whose enthusiasm made this happen: thank you!
Matti Aapro
SIOG Executive Director
Contents
1 Introduction 1
Defining the Elderly 1
Biology of Aging and Changes in Organ Function 1
Changes in Cognition 2
Cancer and Aging 3
Clinical Aspects 3
Further Reading 7
2 Cancer Epidemiology 8
Introduction 8
Population Demographics 8
Cancer Demographics 9
Society-Related Problems 11
Conclusions 12
Further Reading 12
3 Evaluation of the Senior Cancer Patient: Comprehensive Geriatric Assessment and Screening Tools for the Elderly 13
Introduction 13
Short Screening Tools 15
The Vulnerable Elders Survey 13 19
MGA Packages 19
Further Reading 20
4 Frailty in the Elderly 22
Frailty in the Elderly 22
The Impact of Frailty on Cancer 25
Assessment of Frailty 27
Conclusion 28
Further Reading 28
5 Surgical Treatment 29
Introduction 29
Indications for Surgery 29
Patients Selection 30
Outcomes 32
Survival 33
Palliation 33
Side Effects 34
Conclusion 34
Further Reading 35
6 Radiotherapy in the Elderly Cancer Patient 36
Indications for Radiotherapy in the Elderly 36
Side Effects of Radiotherapy in the Elderly (Acute and Late) 37
Efficacy and Outcome of Radiotherapy in the Aging 40
Palliative Setting: Toxicity and Efficacy Ratio 42
Curative Setting: Combinations of Chemotherapy and
Radiotherapy 42
Selection Criteria for Radiotherapy in the Elderly 43
Conclusions 44
Further Reading 45
7 Hormonal Anticancer Treatment in the Senior Cancer Patient 46
Introduction 46
Breast Cancer 46
Prostate Cancer 50
Further Reading 56
8 Cytotoxic and Targeted Anticancer Treatment in the Senior Cancer Patient 57
Introduction 57
Chemotherapy in Senior Adults 57
Targeted Therapies in Senior Adults 61
Further Reading 64
9 Treatment of Lymphoma in the Elderly Population 66
Introduction 66
Diagnosis and Prognosis 66
Treatment 68
Conclusions 70
Further Reading 70
10 Management of Myeloproliferative Diseases in Senior Patients 72
Diagnosis and Classification of Myeloproliferative Disorders 72
Treatment Strategies of MPD in the Senior Patient 76
Conclusions 80
Future Outlook 80
Further Reading 81
11 Myelodysplastic Syndromes in the Senior Patient 82
The Relevance of Myelodysplastic Syndromes in the Elderly 82
Classification and Risk Scoring in MDS 82
Age-Adjusted Models and Assessment in Elderly MDS Patients 85
Treatment Options in Elderly MDS Patients 86
Future Perspectives 90
Further Reading 90
12 Breast Cancer in the Senior Patient 92
Introduction 92
Early Breast Cancer 92
Metastatic Breast Cancer 95
Conclusions 97
Further Reading 97
13 Lung Cancer in the Elderly 98
Introduction 98
Early Non–Small Cell Lung Cancer in the Elderly 98
Advanced Non–Small Cell Lung Cancer in the Elderly 101
Small Cell Lung Cancer in the Elderly 106
Palliative Treatment in Elderly Lung Cancer Patients 107
Conclusion 107
Further Reading 108
14 Colorectal Cancer 109
Introduction 109
Adjuvant Chemotherapy 109
Metastatic Disease 111
Conclusion 113
Further Reading 113
15 Prostate Cancer 114
Introduction and General Background 114
Treatment of Localized Prostate Cancer in Senior Adult
Patients 116
Treatment of Metastatic Prostate Cancer in Senior Adult
Patients 117
Conclusion 118
Acknowledgments 119
Further Reading 120
16 Bladder Cancer 121
Incidence and Mortality 121
Etiology and Risk Factors 121
Pathology 121
Natural History and Tumor Biology 122
Signs and Symptoms 122
Imaging, Cystoscopy, and Urinary Cytopathology 122
Staging 123
Treatment of NMIBC 124
Surgical Treatment 124
Radiotherapy 125
Organ-Sparing Treatments 126
Systemic Chemotherapy 126
Prognosis of BC 126
Follow-Up 127
Further Reading 127
17 Gynecological Cancer in the Senior Patient 128
Introduction 128
Cervical Cancer 128
Uterine Cancer 132
Special Types of Endometrial Malignancy 133
Vaginal Cancer 134
Vulvar Cancer 137
Ovarian Cancer, Fallopian Tube Cancer, and Primary
Peritoneal Cancer 139
Conclusion 142
Further Reading 142
18 Head and Neck Cancer in the Elderly 143
Introduction 143
Surgery 143
Radiotherapy 144
Chemotherapy 145
Targeted Therapies 146
Conclusion 146
Further Reading 147
19 Renal Cell Cancer 148
Introduction 148
Surgery in the Senior Cancer Patient 149
Systemic Therapy of Metastatic Renal Cell Carcinoma
in the Senior Cancer Patient 149
Patient-Focused Approach 153
Conclusion 156
Further Reading 156
20 Psychological Problems in Older Cancer Patients 157
Introduction 157
Depression 157
Anxiety 161
Conclusions 164
Further Reading 164
21 Social and Ethical Aspects 165
Introduction 165
Respect 167
Admiration 167
Attention 167
Information 168
Protection 168
Diagnosis 168
Care 169
Time 169
Caution 170
Freedom 171
Further Reading 171
22 The Role of the Multidisciplinary Team 172
Introduction 172
The Assessment of Age 173
Polypharmacy 175
Management of the Caregiver 176
Function of the Team 178
Conclusions and Perspectives 180
Further Reading 180
Index 181