Geriatric Cardio-oncology
As cancer therapies improve and the population as a whole ages, the number of elderly patients with cancer rises. Aging cancer patients are particularly vulnerable to cardiotoxicity from cancer treatment. Cardiotoxicity results from several factors in old
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Geriatric Cardio-oncology Anne Blaes and Chetan Shenoy
Introduction The incidence of cancer increases with age. As cancer therapies improve and the population as a whole increases, there are rising numbers of elderly patients with cancer. More than half of patients newly diagnosed with cancer are age 65 years or older [1]. In January 2012, it was estimated that more than eight million cancer survivors were older than 65 years, comprising 59 % of the prevalent population of cancer survivors. Estimations predict that by 2050, there will be over 19 million cancer survivors over the age of 85 years [2]. To complicate matters, elderly patients have been underrepresented in cancer clinical trials [3]. Patients older than 65 years historically represented only 38 % of enrolled patients on clinical trials [4]. Concern for toxicity, particularly cardiac-related toxicity and treatmentrelated mortality, has led to lower-intensity regimens in older patients. These factors ultimately have led to relatively few scientific data on how current cancer therapies impact the aging population.
Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-31943096-6_12) contains supplementary material, which is available to authorized users. A. Blaes (*) Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA e-mail: [email protected] C. Shenoy Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 G.G. Kimmick et al. (eds.), Cardio-Oncology, DOI 10.1007/978-3-319-43096-6_12
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A. Blaes and C. Shenoy
Impact of Aging Aging cancer patients are particularly vulnerable to cardiotoxicity from cancer treatment because of their baseline risk resulting from their age [5–7]. In general, older patients have a number of factors, including concomitant medical conditions (comorbidities) and physiologic and functional changes that can affect prognosis, treatment, and outcomes of cancer [6–8]. Approximately 80 % of older adults have one comorbid condition, and 50 % have at least two comorbid conditions. This number increases to over 70 % in patients over 80 years of age [9]. For many of these patients, one of their comorbid illnesses is underlying cardiac disease; in men, approximately 20 % between 60 and 79 years of age and 32 % over 80 years of age have coronary artery disease. In women, approximately 10 % between 60 and 79 years of age and 19 % over 80 years of age have coronary artery disease [10]. When cardiovascular disease is defined as coronary artery disease, heart failure, stroke, or hypertension, the prevalence for men is 69 % between 60 and 79 years of age and 85 % over 80 years of age. Similarly, in women, approximately 68 % of women between 60 and 79 years of age and 86 % over 80 years of age have cardiovascular disease [10]. Not surprisingly, cardiovascular risk factors are frequently present in cancer patients: in a h
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