Features:A strong focus on the field's must-know concepts, from the nature of clinical aging to differential diagnosis of important geriatric syndromes to drug therapy and health servicesNumerous tables and figures that summarize conditions, values, mechanisms, therapeutics, and moreThorough coverage of preventive services and disease screeningAn appendix of Internet resources on geriatricsRecognizing the reality that medical issues interact with other social and environmental issues, Essentials of Clinical Geriatrics includes chapters on Health Services, Nursing Home Care, Ethical Issues in the Care of Older Persons, and Palliative Care.
Seller Inventory LIB Soft cover. New, US Edition , 7th Edition. Premium quality books. Seller Inventory X. Condition: Neu. Neuware - An engaging introductory guide to the core topics in geriatric medicine pp. Robert L. Kane; Joseph G. Ouslander; Itamar B. Kane ; Joseph G. Ouslander ; Itamar B. Abrass ; Barbara Resnick. This specific ISBN edition is currently not available.
View all copies of this ISBN edition:. Synopsis About this title An engaging introductory guide to the core topics in geriatric medicine A Doody's Core Title for ! Buy New View Book. Furthermore, thromboembolic episodes appear to occur more frequently in older individuals who receive bevacizumab [ 47 ]. Finally, oral chemotherapy is an appealing option in seniors, due to better compliance in administering it and greater convenience compared to intravenous chemotherapy.
Metronomic chemotherapy can represent a means of decreasing toxicity [ 48 , 49 , 50 ], thereby enhancing quality of life; moreover, several studies have pointed out the antiangiogenic and immunomodulating effects of this mode of administration [ 51 ]. Insofar as possible, avoid cisplatin and paclitaxel combinations, given their neurotoxicity.
Use drugs with a favorable toxicity profile: weekly vinorelbine, gemcitabine, or taxanes.
Essentials of Clinical Geriatrics 7/E : Robert L. Kane :
Mucositis [ 53 , 54 ]. In addition to impacting quality of life in people with cancer, oral mucositis influences treatment decisions and often necessitates dose reductions and delay or even treatment withdrawal. Being older and female are two risk factors for mucositis, for reasons as yet unknown. Deficient nutritional status, smoking, alcohol use, and periodontal disease are other patient-related risks. Attention to new drugs, such as palifermin keratinocyte growth factors [ 55 , 56 ]. Historically, when treatment intent was palliative, chemotherapy dose reduction was widespread to decrease the incidence of neutropenia in patients at risk.
However, more recent publications maintain that G-CSF use would be justified if treatment intent is to prolong survival, even when it is not curative [ 57 ]. In short, we believe that the use of colony-stimulating factors should be at least contemplated in all seniors who receive cytotoxic chemotherapy. We must also be especially alert to anemia secondary to chemotherapy and begin early treatment with erythropoietin as per guideline recommendations, particularly in patients with certain comorbidities cardiac or respiratory , as anemia can have a major clinical and functional impact.
Our recommendation, therefore, is that any cancer individual that has no possibility for radical oncological treatment undergoes early evaluation by a Palliative Care team, especially if said individual is older, and for this assessment to be on-going throughout the entire process. Despite all the difficulties incumbent in defining and quantifying social support, we believe that its necessity is evident and that it must be appraised and optimized for proper treatment planning for seniors with cancer.
Skip to main content Skip to sections. Advertisement Hide. Download PDF. Authors Authors and affiliations R. Antonio Rebollo M. Molina Garrido C. Blanco E. Gonzalez Flores J. Open Access. First Online: 09 April Two consensus statements were drafted to determine the domains and scales to be used. One was carried out in United States [ 27 ] and the other was conducted at the international level [ 28 ]; in both cases, consensus was reached. Treatment and comorbidity stabilization The presence of comorbidities can affect the treatment of cancer in seniors in very different ways [ 29 ]: comorbidities can influence how cancer behaves [ 30 ] and can hasten or delay its diagnosis; cancer treatment can worsen the comorbidity or entail unacceptable risk; the presence of comorbidities can condition life expectancy [ 31 ], and, finally, comorbidities can affect the results of oncological treatment [ 32 ].
Specific intervention on the geriatric syndromes detected As previously described, geriatric syndromes can be detected by CGA, evaluating the different biomedical and psychosocial domains as per protocol. Avoiding polypharmacy Inappropriate drug prescription is especially common in older people and is associated with a higher risk of drug-related adverse events, more hospitalizations, and inappropriate resource use [ 40 , 41 ]. Selection of low-toxicity treatment regimes Systemic treatment of older individuals with cancer poses a challenge for the oncologist, given the variety of situations that must be attended to and the lack of published evidence in most cases.
Consequently, our general recommendations for this point would be: Insofar as possible, avoid cisplatin and paclitaxel combinations, given their neurotoxicity. Use capecitabine instead of 5-FU infusion. Exercise caution with the use of antiangiogenics. Avoid concurrent chemo-radiotherapy treatments.
Consider the benefits of metronomic chemotherapy. Indeed, already in , SIOG recommended that colony-stimulating factors and erythropoietin be considered a fundamental element of treatment for senior cancer patients who are receiving chemotherapy, whether for radical or palliative purposes [ 59 ]. With respect to erythropoietin, it must be remembered that in older individuals, the symptoms that precede the anemia can quickly lead to a decline of their functional dependence. Together with the previously named support and recommendations, it is extremely important to ensure optimal symptomatic control by means of a multidisciplinary approach [ 60 , 61 ].
Treatment aims must be determined to enhance outcomes. Symptom management is similar in older and younger patients, but symptoms in seniors can be associated with complications that are both more common and more serious.
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In certain neoplasms, such as lung cancer, early palliative treatment associated with cancer-specific treatment has proven to go so far as to influence survival [ 62 ]. There is little agreement in the literature as to what constitutes adequate social support [ 64 ]. Some studies have attempted to quantify social support based on the number of relatives, for instance. Compliance with ethical standards Conflict of interest The authors have declared no conflicts of interest. Informed consent The informed consent is not applicable in this paper.
Preparing for an epidemic: cancer care in an aging population. CrossRef Google Scholar. Delphi consensus of an expert committee in oncogeriatrics regarding comprehensive geriatric assessment in seniors with cancer in Spain.
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J Geriatr Oncol. Crit Rev Oncol Hematol. Hurria A. Senior adult oncology, version 2. J Natl Compr Cancer Netw. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol. Bhutto A, Morley JE. The clinical significance of gastrointestinal changes with aging.
Sharma G, Goodwin J.
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Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. Google Scholar. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet London, England. Multidimensional geriatric assessment reveals unknown medical problems in elderly cancer patients. J Clin Oncol. Wang, Suzanne B. Kitzma and George Taffet Bell, and Susan J. Zieman Coronary Heart Disease, Eric D. Peterson and Shahyar M. Gharacholou Edwards Heart Failure, Michael W.
Rich Peripheral Vascular Disease, Andrew W. Gardner, John D. Sorkin, and Azhar Afaq Hypertension, Mark A. Supiano Section C: Respiratory System Aging of the Respiratory System, Paul L. Enright Newman, and don Sin Thannickal and Galen B. Toews Section D: Nephrology Patel Sands, and James L. Bailey Unruh Hall Maratchi and David A. Greenwald Rao and Harvey Jay Cohen Breast Disease, Gretchen G. Kimmick and Hyman B. Muss Prostate Cancer, Kenneth J. Pienta Perry Gastrointestinal Malignancies, Nadine A. Jackson and Peter C. Enzinger Intracranial Neoplasms, Noelle K.
LoConte, Julie E. Chang, and H. Ian Robins Skin Cancer, Mathew W. Ludgate, Timothy M.
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Johnson, and Timothy S. Wang Section G: Hematology Aging of the Hematopoietic System, Gurkamal S. Chatta and Daniel A. Lipschitz Anemia, Paulo H. Chaves White Cell Disorders, Heidi D. Klepin and Bayard L. Powell Longo Ginsberg, adn Clive Kearon Hemorrhagic Disorders, Julia A. Anderson and Agnes Y. Lee Section H: Endocrinology and Metabolism Gruenewald and Alvin M. Matsumoto Thyroid Diseases, Jerome M. Hershman, Sima Hassani, and Mary J. Samuels Diabetes Mellitus, Annette M.
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Chang and Jeffrey B. Halter Dyslipoproteinemia, Leslie I. Katzel, Jacob Blumenthal, John D. Sorkin, and Andrew P. Goldberg Aging of the Muscles and Joints, Richard F. Loeser, Jr. Biomechanics of Mobility, James A. Ashton-Miller and Neil B. Alexander Schwartz and Wendy M. Kohrt Osteoarthritis, Shari M. Lang and Yvette L. Ju Osteoporosis, Gustavo Duque and Bruce R. Troen Hip Fractures, Ram R. Miller, Colleen Christmas, and Jay Magaziner Nakasato and Bruce A.