The advent of the electronic medical record offers a unique opportunity to per­form studies in such a way that the major­ity of older patients with cancer can be included in research trials. As long as all relevant information related to function, comorbidity, emotional status, and social support is included within the medical re­cord, it may become possible to create pre­cise prognostic models that help deliver personalized care to older patients with cancer. Such is the aim of the project Can­cerLinQ, which is a system designed by the American Society of Clinical Oncology.32

Conclusions


Continue Reading

Age should not be considered a criterion for disquali­fying a person with cancer from a clinical trial. Phase 2 trials dedicated to older individuals are necessary to establish the pharmacology of novel agents in the older patient population. Phase 3 trials that study the older patient population should stratify patients ac­cording to life expectancy and treatment risks. Registry studies with prospective data collection are necessary to encompass the diversity of all older individuals.


From the Senior Adult Oncology Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, and the De­partment of Oncologic Sciences at the University of South Florida Morsani College of Medicine, Tampa, Florida.

Submitted January 26, 2014; accepted March 13, 2014.

Address correspondence to Lodovico Balducci, MD, 12902 Magnolia Drive, Tampa, FL 33612. E-mail: [email protected]

No significant relationship exists between the author and the com­panies/organizations whose products or services may be referenced in this article. 


References

1. Balducci L, Aapro M. Complicated and complex: helping the older cancer patients to exit the labyrinth. J Ger Oncol. 2014;5(1):116-118.

2. Tettamanti M, Lucca U, Gandini F, et al. Prevalence, incidence, and types of mild anemia in the elderly: the “Health and Anemia” population-based study. Hematologica. 2010;95(11):1849-1856.

3. Hurria A, Wildes T, Blair ST, et al. Senior adult oncology, version 2.2014: clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2014;12(1):82-126.

4. Yourman LG, Lee SJ, Schonberg MA, et al. Prognostic indices for older adults: a systematic review. JAMA. 2012;307(2):182-192.

5. Lee SJ, Leipzig RM, Walter LC. Incorporating lag time to benefits into prevention decisions for older adults. JAMA. 2013;310(24):2609-2610.

6. Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemo­therapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118(13):3377-3386.

7. Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxic­ity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457-3465.

8. Balducci L, Goetz-Parten D, Steinman MA. Polypharmacy and the man­agement of the older cancer patient. Ann Oncol. 2013;(24 suppl 7):vii36-40.

9. Mohile SG, Fan L, Reeve E, et al. Association of cancer and geri­atric syndromes in older Medicare beneficiaries. J Clin Oncol. 2011;29(11): 1458-1464.

10. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;(9 suppl 2):S51-S63.

11. Mitnitski A, Song X, Rockwood K. Assessing biological aging: the origin of deficit accumulation. Biogerontology. 2013;14(6):709-717.

12. Huffman KM, Pieper CF, Kraus VB, et al. Relations of a marker of en­dothelial activation (s-VCAM) to function and mortality in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2011;66(12):1369-1375.

13. Sanders JL, Newman AB. Telomere length in epidemiology: a biomarker of aging, age-related disease, both, or neither? Epidemiol Rev. 2013;35(1): 112-131.

14. Falandry C, Gilson E, Rudolph KL. Are aging biomarkers clinically relevant in oncogeriatrics? Crit Rev Oncol Hematol. 2013;85(3):257-265.

15. Juliusson G, Antunovic P, Derolf A, et al. Age and acute myeloid leu­kemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood. 2009;113(18):4179-4187.

16. Turner N, Zafarana E, Becheri D, et al. Breast cancer in the elderly: which lessons have we learned? Future Oncol. 2013;9(12):1871-1881.

17. Balducci L, Ershler WB. Cancer and aging: a nexus at several levels. Nat Rev Cancer. 2005;5(8):655-662.

18. Evans JL, Goldfine ID. Aging and insulin resistance: just say iNOS. Diabetes. 2013;62(2):346-348.

19. Velarde MC, Demaria M, Campisi J. Senescent cells and their secre­tory phenotype as targets for cancer therapy. Interdiscip Top Gerontol. 2013; 38:17-27.

20. Margel D, Urbach DR, Lipscombe LI, et al. Metformin use and all-cause and prostate cancer-specific mortality among men with diabetes. J Clin Oncol. 2013;31(25):3069-3075.

21. Chlebowski RT, McTiernan A, Wactawski-Wende J, et al. Diabetes, metformin, and breast cancer in postmenopausal women. J Clin Oncol. 2012;30(23):2844-2852.

22. Hoffe S, Balducci L. Cancer and age: general considerations. Clin Geriatr Med. 2012;28(1):1-18.

23. Tadmor T, McLaughlin P, Polliack A. Chemoimmunotherapy with fluda­rabine, cytoxan and rituximab regimen: to use, not to use, or give it as “FCR-LITE”? Leuk Lymphoma. 2014;55(4):733-734.

24. Freedman VA. Research gaps in the demography of aging with disability. Disabil Health J. 2014;7(1 suppl):S60-S63.

25. Kemeny MM, Peterson BL, Komblith AB, et al. Barriers to clini­cal trial participation by older women with breast cancer. J Clin Oncol. 2003;21(12):2268-2275.

26. Muss HB, Berry DA, Cirrincione CT, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med. 2009;360(20): 2055-2065.

27. Meoni G, Cecere FL, Lucherini E, et al. Medical treatment of advanced non-small cell lung cancer in elderly patients: a review of the role of chemo­therapy and targeted agents. J Geriatr Oncol. 2013;4(3):282-290.

28. Bastion Y, Blay JY, Divine M, et al. Elderly patients with aggressive non-Hodgkin’s lymphoma: disease presentation, response to treatment, and survival–a Groupe d’Etude des Lymphomes de l’Adulte study on 453 patients older than 69 years. J Clin Oncol. 1997;15(8):2945-2953.

29. Goede V, Fischer K, Busch R, et al. Obinutuzumab plus chlorambucil in patients with CLL and coexisting conditions. N Engl J Med. 2014;370(12): 1101-1110.

30. Sanoff HK, Carpenter WR, Stürmer T, et al. Effect of adjuvant chemo­therapy on survival of patients with stage III colon cancer diagnosed after age 75 years. J Clin Oncol. 2012;30(21):2624-2634.

31. Lyman GH, Dale DC, Wolff DA, et al. Acute myeloid leukemia or myelo­dysplastic syndrome in randomized controlled trials of cancer chemotherapy with granulocyte colony-stimulating factor: a systematic review. J Clin Oncol. 2010;28(17):2914-2924.

32. American Society of Clinical Oncology. CancerLinQ. http://www.asco. org/quality-guidelines/cancerlinq. Accessed April 22, 2014.


Source: Moffitt Cancer Center.