Think Beyond Cancer
ELDERS ONCOGERIATRICS CANCER

Age is a risk factor for cancer due to the duration of carcinogenesis, the vulnerability of aging tissues to environmental carcinogens, and other bodily changes that favor the development and the growth of cancer. Age may also influence cancer biology: Some tumors become more aggressive (ovarian cancer) and others, more indolent (breast cancer) with aging. Aging implies a reduced life expectancy and limited tolerance to stress. A comprehensive geriatric assessment (CGA) indicates which patients are more likely to benefit from cytotoxic treatment. Some physiologic changes (including reduced glomerular filtration rate, increased susceptibility to myelotoxicity, mucositis, and cardiac and neurotoxicity) are common in persons aged 65 years and older. The administration of chemotherapy to older cancer patients involves adjustment of the dose to renal function, prophylactic use of myelopoietic growth factors, maintenance of hemoglobin levels around 12 g/dL, and proper drug selection. Age is not a contraindication to cancer treatment: With appropriate caution, older individuals may benefit from cytotoxic chemotherapy to the same extent as the youngest patient

Although more than half of all cancers occur in people above the age of 65, the good news is that elderly people can benefit from cancer treatment to the same degree as younger patients. While some treatments may have not been considered for the care of older patients formerly, things have changed. The elderly are getting healthier and living longer, and are entitled to benefit from the many life-saving medical advances new to Oncology.

Diagnosis
Warning signs are often minimized, because they also can be caused by usual diseases of aged patients. More over, after a certain age, some screenings like breast cancer or uterus cervix cancer, aren't done anymore.

Treatments
Cancer treatments today can range from minor surgical procedures to the use of chemical or alternative therapies. Treatment for the elderly is usually prescribed for those with early-onset cancer who are in overall good physical and mental condition; age is not always the primary factor when deciding who should receive cancer care. Once cancer is diagnosed in an elderly person, the best approach it is to work closely with a medical team that specializes in cancer treatment in older adults. The elderly have special medical, physical, nutritional, spiritual and emotional needs that can make the difference in how well they respond to treatment. They are typically already undergoing some treatment for other serious health issues such as diabetes, high blood pressure, heart attacks, strokes and arthritis. They are also more likely to be receiving drugs for these conditions, and the potential for drug interactions and complications require thorough medical histories, accurate information about current medications and close monitoring following any treatment

- Surgery: it's more and more performing, but there are after effects specific to elderly people, like thrombosis, eschars, or sometimes memory disorders. The choice of doing a surgery or not will depend most on the general health state than the age. It's thus important to know all the patient's risk factors, particularly kind and length of operation, associated diseases, phlebitis antecedents or alteration in cerebral functioning. Preventive treatments for eschars and thrombosis can be put in place.

- Radiotherapy: this kind of treatment is responsible for important after effects that can be very difficult to support for elders. Sometimes it's necessary to adapt the treatment by choosing methods that reduce the number of radiotherapy sessions and the total length of treatment.

- Chemotherapy: it has to be adapted to the general state of the patient, his nutritional state, his way of life, his familial environment and the place where he lives. For some cancers, there are now oral forms, which are easier for the patient but needs to respect precisely the doses and hours of administration. Concerning the adverse effects, haematotoxicity seems more frequent and serious in old patients.

- Hormonotherapy: hormones are used in the treatment of breast cancer and prostate cancer. They lead to after effects that can be serious if they affect elder people. In women, tamoxifen increases the risk of phlebitis and must not be prescribed in case of vascular troubles or varicose vein antecedents. Letrozole, astranozole and exemestane can provoke articular or bone pain, and can increase the risk of fractures, so in some cases it can be necessary to prescribe calcium. In men, anti-androgens can provoke digestive disorders (lack of appetite, diarrhoea, abdominal pain).

Providing Support During Treatment
It is well known that in treating cancer, mind over matter is often the key to a successful response to treatments such as chemotherapy, radiation therapy and nutritional therapy, even surgical removal, if needed. Keeping the patient in good spirits and providing adequate support will often lessen the fears associated with having the disease. This will in turn improve the response and recovery time of the cancer treatment. Despite a desire to live independently, the elderly person may need some assistance with normal household duties or errands like getting to and from doctor appointments and scheduled treatments. It's important that either the elderly person's family get involved or that a nursing care plan be put into effect that supplies whatever extra support is needed. An elderly person should not be left to face cancer alone.

The best in cancer treatment
Close physician-managed cancer treatment is the best, most effective choice. This is to offset any potential hazards associated with treatments for any other health conditions. Quality of life is an important factor that needs to be taken into account before starting a new regimen of treatment of an elderly person.

Many traditional and alternative treatments are very successful in providing a cure or keeping the cancer in remission for years, giving the elderly person an excellent outlook on the future and a good quality of life. A carefully managed medical plan carried out by a supportive Oncology team and loving friends and family will help make this challenging time turn out for the best for the elderly person dealing with cancer.

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