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Flashcards in Cancer Deck (9)
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1

The incidence of CA increases with age up to ____ at which point it levels off.

What is the single biggest risk factor in the development of cancer?

60% of all CAs occur in those age 65 or older, T/F?

70% of all cancer deaths occur in those age 65 or older, T/F?

75 years old

Aging is the biggest risk factor

True

True

2

The biological behavior of the cancer changes with aging. What are some ways this occurs?

Blunted T cell activity and decreased NK cell activity

CA growth factors differ with age
-IL-6 increases with age
-Angiogenesis is altered
-chronic inflammation may promote tumor growth

3

What are some cancers that have a more indolent course in the elderly? (3)

More aggressive? (3)

Most common Cancers overall (4)

Indolent
-some non-small cell lung adenocarcinomas
-estrogen/progesterone responsive positive breast CA
-Prostate CA

Aggressive
-AML
-Large cell non-hodgkin lymphoma
-celomic ovarian cancer

Most common
-breast
-prostate
-lung/bronchus (This is the most common CA in geriatric pts ages 55-74)
-colon and rectum

4

Why are cancer death rates so high in elderly patients?

-organ vulnerability
-co-existing illnesses
-more aggressive tumors
-more likely to have advanced disease at presentation
-age bias: under treatment, reduced participation in CA screening programs, under-representation in clinical trails, health care access issues

5

Treatment of CA
-surgery: what are the risk factors for the elderly
-radiation: what are the risks for the elderly
-chemo: downfalls to this tx in the elderly

Surgical risk factors for elderly
-emergency surgery or prolonged surgery
-co-existing disease (especially CVD, COPD, DM)
-poor nutritional status (wound healing, infections)
-poor functional status

Radiation
-overall very safe and convenient
-major risks: mucositis (dehydration, malnourishment, sepsis) and radiation pneumonitis

Chemo
-more SE than surgery or RT
-increased susceptibility to toxicity
-dose adjustments for reduced GFR or anemia leads to decreased treatment effectiveness
-major risks: myelosuppression (anemia, neutropenia, thrombocytopenia), mucositis (dehydration, malnutrition, sepsis), drug specific toxicities

6

What is Ca tx based on?

The TUMOR CHARACTERISTICS, not the age of the patient

*include risk of tc vs benefit and effects on quality vs quantity of life

7

What is physiologic age?

good estimate of quality of life, life expectancy, and ability to tolerate CA tx

components include: co-morbidities, functional status (ADLs, IALDs), nutritional status, geriatric syndromes (dementia, delirium, depression, falls, spontaneous fx, neglect, abuse, incontinence, nutritional problems)

8

How do we treat CA if the elderly pt is frail?

If frail, palliative tx

If not, llife prolonging tx

intermediate, individualize tx

*treatment is not always warranted

9

Cancer in the elderly
-supportive care examples (things to treat their SE)

-nutritional support: dietary counseling/supplements, G/J tube
-anemia: epoetin alpha
-Neutropenia: epogen or leukine
-Thrombocytopenia: platelet infusion
-Mucositis: supportive care, hydration, magic mouth wash
-N/V: serotonin receptor antagonists (ondansetron)
-Pain: often undertreated in the elderly*
--pt reluctance to report pain
--atypical presentation
--providers fear older pts wont tolerate opiates
--communication problems