Guidelines for the Management of the Older Cancer Patient

Abstract

Evaluation of: Balducci L, Cohen HJ, Enstrom PF et al.: Senior adult oncology clinical practice guidelines in oncology. J. Natl Compr. Cancer Center Netw. 3, 572–590 (2005). The management of older cancer patients with cytotoxic chemotherapy involves a new balance of benefits and risks, given the limited life expectancy and increased susceptibility to therapeutic complications of older individuals. The National Cancer Center Network has been issuing guidelines for the management of older cancer patients since 1999. This article reviews the basis of the most recent set of guidelines, issued in 2005. These include: some form of geriatric assessment for individuals aged 70 years and older to estimate their life expectancy and treatment tolerance; adjustment of the first dose of chemotherapy to glomerular filtration rate for individuals aged 65 years and older; prophylactic use of myelopoietic growth factors (e.g., filgrastim or pegfilgrastim) in patients aged 65 years and older treated with moderately toxic chemotherapy (of which cyclophosphamide, doxorubicin, vincristine and prednisone is the paradigm); maintainance of hemoglobin levels at approximately 12 gm/dl; and preferential use of drugs of low toxicity (e.g., capecitabine, pegylated liposomal doxorubicin, weekly taxanes, gemcitabine or navelbine).