Determining appropriate treatment for elderly patients with cancer

The physiological reserves of elderly patients with cancer were evaluated and the most relevant biomarkers indicating their functional biological age were described in a recent publication by the Elderly Task Force of the European Organization for Research and Treatment of Cancer (EORTC).

The Elderly Task Force of EORTC was chaired by Hans Wildiers, MD, PhD, of the University Hospitals Leuven in Belgium. He was a coauthor of this study, which was published in the Journal of Geriatric Oncology (2013; doi:10.1016/j.jgo.2013.09.001).

Many things, not simply chronological age, contribute to treatment tolerance and outcome in older patients with cancer. These aspects present challenges when determining appropriate treatment.

As we age, we experience a progressive decline in many of our bodily functions. This decline can vary greatly from person to person. One person, age 75 years, might still be very active and participate in strenuous physical activities, whereas another of the same age might require considerable assistance just to perform simple everyday tasks. Aging is variable and a highly individualized process influenced by a number of genetic, developmental, and environmental factors.

 “The incidence of most malignant diseases increases with age. Studies have shown that slightly more than half of all newly diagnosed cancer cases and more than two-thirds of cancer-related deaths occur in patients age 65 years or older. So, we expect the number of older patients with cancer will increase as the population ages. Doctors will increasingly need to make treatment decisions for older patients, and to make effective decisions, we will need better biological markers of aging,” said Wildiers.

The EORTC Cancer in the Elderly Task Force study provides a guideline on integrating several potential biomarkers of aging: inflammatory markers, telomere length and telomerase activity, genetic predisposition for longevity, gene expression of aging-related genes in peripheral blood mononuclear cell, immunosenescence, lymphocyte senescence p16INK4a expression in T lymphocytes, and plasma microRNA expression profile.

They point out that comprehensive geriatric assessment can provide information on the general health status of individuals, but that it is far from perfect as a prognostic or predictive tool for individual patients. Alternatively, biological changes in certain tissues which are the result of adaptive alterations due to past exposures, as well as the natural aging process, can help to assess aging.

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