Chemotherapy toxicity - #37
Take QuizReview toxic affects of chemo therapy on geriatric patients.
Crucial Questions: Three questions to ask when assessing an elderly patient with cancer include:
1. Will this patient die from this cancer or with this cancer?
2. Is this patient at risk for complications from this cancer?
3. Is this patient able to tolerate cancer treatment?
Prior to initiation of chemotherapy, an extensive evaluation is required to assess appropriateness of treatment for that individual patient. While there is not an absolute age-determined cutoff for receiving chemotherapy, physical, cognitive, functional and social factors help determine a geriatric patient's ability to tolerate chemotherapy.
Chemotherapy Toxicity:
The most common scale for assessing toxicity from chemotherapy was developed by ECOG and graded from 0-5 with 0 being no change from baseline and 5 being death from toxicity.
Please see Geriatrics Fast Fact #36 entitled, “Should your patient have that oncology intervention?” for more detailed information on comprehensive geriatric assessment.
A geriatric patient with cancer, in the outpatient or inpatient clinical setting.
Determine potential chemotherapy toxicities to elderly patients undergoing treatment for cancer.
Cancer is a significant source of morbidity and mortality for the elderly, with 53% of new cancers being diagnosed in those greater than 65 years old. The risk of developing cancer increases in men from 1 in 6 men (between ages 60-69) to 1 in 3 men (after age 70 years); for women the risk increases from 1 in 10 to 1 in 4 for the same age distributions. Data regarding the toxic effects of chemotherapy in geriatric patients is often limited due to frequent exclusion from clinical trials. A Cancer and Aging Research Group study that evaluated 500 patients >65 years (mean 73 years) with stage I to IV cancer showed 1 or more grade 3-5 toxicity occurrence in 53% of patients. The International Society of Geriatric Oncology Taskforce performed a review in 2007 of chemotherapy for elderly patients. The common toxicities associated with various chemotherapy regimens are found in Table 1.
Science Principles
• List 3 crucial questions to ask when assessing an elderly patients appropriateness for chemotherapy treatment.
• Identify potential toxicities associated with common chemotherapy agents.
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
- SEER cancer statistics review 1975-2010. National Cancer Institute, http://seer.cancer.gov/csr/1975_2010/.
- Cancer facts and figures 2013. American Cancer Society, http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2...
- Hurria A, Browner IS, Cohen HJ, Denlinger CS. NCCN Guidelines: Senior Adult Oncology. J Natl Compr Canc Netw, 2012; 10:162-209.
- Repetto L. Greater risks of chemotherapy toxicity in elderly patients with cancer. J Support Oncol 2003; 1(suppl 2): 18-24.
- ECOG Common Toxicity Criteria. Eastern Cooperative Oncology Group. Rober Comis MD, Group Chair. http://ecog.dfci.harvard.edu/general/ctc.pdf
- 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: 3457-3465.
- Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part I. Cancer J 2005; 11: 449-460.
- Sehl M, Sawhney R, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J 2005; 11:461-473.
- Lichtman SM, Wildiers H, Chatelut E, et al. International society of geriatric oncology chemotherapy taskforce: evaluation of chemotherapy in older patients-an analysis of the medical literature. J Clin Oncol 2007; 25: 1832-1843.
- Gonsalves W, Ganti AP. Targeted anti-cancer therapy in the elderly. Crit Rev Oncol Hematol 2011; 78: 227-242.
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