Challenges in Managing Elderly Cancer Patients: A Systematic Review

Abstract

17 Challenges in Managing Elderly Cancer Patients: A Systematic Review Presenting author: S.H. Huang Integrated Research/Clinical Radiation Therapist, Princess Margaret Cancer Centre, Canada E-mail address: ShaoHui.Huang@rmp.uhn.on.ca Introduction and Purpose: With the extension of life expectancy, the proportion of elderly cancer patients is increasing, especially in Western world. Decision-making for them is challenging, mainly due to their large biological heterogeneity, uncertainty of life expectancy, and lack of objective assessment tools. Many factors may influence treatment decision, such as co-morbidity; performance status, supportive care, mental status, patient’s or family’s wishes. There is a paucity of data available in terms of assessing treatment tolerance in elderly patients. While chronological age is an unreliable index, elderly patients were often excluded from clinical trials. This review will describe challenges in managing elderly cancer patients. Methods: All articles regarding ‘‘elderly’’, ‘‘cancer’’, ‘‘age-related physiological changes’’, ‘‘treatment’’, ‘‘radiation’’, ‘‘chemotherapy’’, and ‘‘geriatric assessment’’ published between January 1, 2002 and November 1, 2012 were searched through MEDLINE and EMBASE. The findings are summarized into few categories. Results: This review is focusing on: 1). Describe the normal age-related physiological changes in neurologic, cardiovascular, pulmonary, gastrointestinal, genitourinary, muscular skeletal changes, hematologic, and skin changes, 2). Elaborate how radiation and chemotherapy can aggregate these changes, 3). Reviewing how these changes may impact on treatment tolerance, sequalae and outcomes, including reviewing researches on treatment efficacy for elderly cancer population, 4). Explain the importance and available assessment tool for screening treatment tolerance, 5). Discuss the role of radiation therapist in caring elderly cancer patients including identifies vulnerable elder patient, and early intervention for symptom management. Conclusion: Managing elderly cancer patients is challenging. Understanding age-related and treatment-related changes is important for health care professionals. Radiation therapist plays a key role in early identifying vulnerable elderly patients and prompting necessary supportive care are especially crucial for achieving optimal outcomes in elderly population.