What Chemotherapy Is Practicable in Aged Patients?
The number of elderly patients diagnosed with rectal cancer (RC) is very high and, considering colon and rectal cancer (CRC), is one of the leading causes of cancer-related death in the elderly [1]. However, the number of older patients enrolled in clinic
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Carmelo Pozzo and Ernesto Rossi
The number of elderly patients diagnosed with rectal cancer (RC) is very high and, considering colon and rectal cancer (CRC), is one of the leading causes of cancer-related death in the elderly [1]. However, the number of older patients enrolled in clinical trials is underrepresented and in most cases elderly population undertreated. Although, with the introduction of new treatments and better diagnostic techniques and surgical procedures, a better outcome is achievable today also in elderly patients diagnosed with resectable or metastatic rectal cancer, overall survival rate remains low. This is probably due to less aggressive diagnostic evaluation; less intensive chemotherapy, including anticipatory drug dose reduction or empiric schedule alteration; less aggressive surgery; and, finally yet importantly, also social conditions and limited access to healthcare system of elderly population with cancer. Available data regarding rectal cancer in older patients are primarily retrospective. Furthermore, most of trials do not recruit patients >75 years old, and this lack of clear evidences could be a bias for establishing clinical guidelines of older adult oncology and may represent a further
C. Pozzo (*) • E. Rossi Oncolgia Medica, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy e-mail: [email protected]
reason for undertreatment. The other crucial issue of treating older patient, particularly with RC, is to avoid medical-induced morbidity and mortality. Adverse events can be more severe and recover much slower in older patients as compared with younger population, so that the expected benefit can be finally uncertain. Elderly patients commonly present with other age-related health problems and among them, many are actually “frail” patients for various medical and social conditions. Performance status and tumor stage are in general good predictors of outcome and tolerability for younger patients; however, for older patients other conditions have to be taken into account, like cognitive impairment, disabilities, and comorbidities. The comprehensive geriatric assessment (CGA) is a validated multidisciplinary evaluation tool that can be used to assess the risk of mortality, morbidity, and life expectancy and guide the optimal treatment in an older patient [2, 3, 14, 15]. Due to the complexity of CGA tools and the long time needed in many cases before starting a cancer treatment, a cancer-specific geriatric assessment has been developed for elderly cancer patients, assessing seven domains including functional, nutritional, psychological status, social functioning, and support [4]. A prospective multicenter trial with 500 older cancer patients showed that CSGA is useful to predict chemotherapy-related toxicity in older adults with cancer [5].
© Springer-Verlag Berlin Heidelberg 2018 V. Valentini et al. (eds.), Multidisciplinary Management of Rectal Cancer, https://doi.org/10.1007/978-3-319-43217-5_42
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