749 research outputs found
Cancer in the older person
No full textCancer in the older person is an increasingly common problem, due to the progressive prolongation of the life-expectancy of the Western population. This article reviews the mechanisms associating aging and cancer, age-related changes in cancer biology, assessment of the older person to estimate life-expectancy, treatment tolerance, and medical and social conditions that may interfere with cancer treatment, effectiveness of cancer prevention and cancer treatment in older individuals. A comprehensive geriatric assessment (CGA) is commonly used to predict life-expectancy and functional reserve and to unearth conditions that may jeopardize cancer prevention and treatment. In the interest of cost and time, shortened forms of CGA are being explored. Chemoprevention of cancer is a promising form of prevention that at present has no conclusive clinical indications. Early diagnosis of breast and colon cancer through screening of asymptomatic patients at risk may be beneficial for individuals with a life-expectancy of 5 years or longer. Early detection of lung cancer in ex-smokers is undergoing clinical trials, as this disease is becoming more and more common. Age should not prevent appropriate treatment of cancer in older individuals, especially in those with adequate life-expectancy and functional reserve. The National Cancer Center Network (NCCN) has issued a series of guidelines to minimize the toxicity and promote the effectiveness of cancer in older patients. Important interventions include prevention of neutropaenic infections with filgrastim and peg-filgrastim, prevention of anaemia with epoietin or darbepoietin, and prevention and early management of mucositis
Rilavorazione quattrocentesca di un marmo antico nel chiostro di San Giorgio a Moneglia.
No full textPubblicazione di un'inedita stele antica rilavorata nel '400
Colorectal Cancer in Older Adults: Surgical Issues
No full textThis chapter centers on what surgeons, patients, and hospital administrations want and need to know about surgical care for colorectal cancer in the older patients. From all angles, it is clear that older patients are unique and their colorectal cancer care should be individualized and approached in a multidisciplinary fashion. Evaluation of patient fitness to undergo surgery should be undertaken in the elective and emergent settings. If patients are deemed fit for treatment, they should be offered the appropriate treatment, regardless of their age. This includes proceeding with surgery and/or chemotherapy and utilizing minimally invasive techniques, when appropriate. In addition, quality of life should be a priority in the care of older patients and patient reported outcomes should be assessed and reported. © Springer Nature Switzerland AG 2020
Geriatric Oncology
No full textThe decrease in muscle mass and strength represents one of the most relevant descriptor of physiological aging. Sarcopenia is the term coined to indicate the pathologic loss of skeletal muscle mass and strength/function during aging. The skeletal muscle decline has a multifactorial origin, involving lifestyle habits, disease triggers, and age-dependent biological changes. This phenomenon is part of the geriatric background and is today starting to disseminate in other specialties dealing with the complexity of frail older persons. In the oncology field, the interest in muscle wasting has mostly been focused on the clinical entity of cancer cachexia, a complex metabolic syndrome characterized by severe muscle loss, systemic inflammation, and malnutrition. The study of body composition in the oncological setting is crucial and may become one of the main characterizations of the oncogeriatric field, where clinical and research actions have to be designed taking into account the consequences of the aging process
MAX2 - A convenient index to estimate the average per patient risk for chemotherapy toxicity: Validation in ECOG trials
No full textCancer patients, especially the elderly, present with a highly variable susceptibility to toxicity from chemotherapy. To estimate correctly a patient’s risk for toxicity, both the average toxicity of a chemotherapy regimen and patient-related variables need to be assessed. However, treatment toxicities are typically reported item by item, not summarised per patient. We tested an index derived from a pilot study, the MAX2, on the ECOG database. Studies including 20 or more patients aged 70 years and older per arm were selected. Four studies were identified, representing 2526 patients, 410 (16%) being elderly. The association of the MAX2 index with the per patient incidence of grade 4 haematological and/or grade 3 or 4 non-haematological toxicity was highly significant, both for the overall group and for the elderly subgroup. The MAX2 index is a convenient and reproducible way of comparing the average per patient risk for toxicity from chemotherapy across several regimens
MAX2: a convenient index to estimate the average per patient risk of severe toxicity from a chemotherapy regimen. Testing in ECOG studies (Abstract)
No full textAbstract 1459, May 200
Fatigue and functional dependence in older cancer patients
No full textFunctional dependence is a costly manifestation of aging that compromises the quality of life of elderly individuals and their caregivers. In this study, we hypothesized that fatigue may be a cause of functional dependence in older cancer patients. To establish whether fatigue was associated with dependence in 1 or more activities of daily living (ADLs) or instrumental activities of daily living (IADLs), and declining performance status (PS). In addition, we studied the prevalence of fatigue and its correlation with anemia, depression, and nutritional status. MATERIALS AND METHODS: Retrospective cross-sectional study of 214 patients aged 70 and older were seen over a 3-month period by the Senior Adult Oncology Program of the H. Lee Moffitt Cancer Center in Tampa, FL. Each patient was screened with a questionnaire assessing ADLs, IADLs, PS, cognitive impairment, depression, and malnutrition. In addition, each patient underwent assessment of fatigue with the fatigue symptom inventory and a determination of complete blood counts and complete chemical panel. RESULTS: Fatigue was reported by 81% of the patients. The interference score of fatigue seemed to be a mediator for dependencies in ADLs and IADLs (P < 0.001 and 0.001), and poorer PS (P < 0.001). CONCLUSIONS: Fatigue is a common chronic problem for older cancer patients and may represent a major cause of functional dependence
Principles of Cancer Surgery in Older Adults
No full textThe elderly population has recorded an unprecedented growth over the last 20 years. Despite the evidence that cancer is a disease of the elderly, very little level 1 evidence on its treatment comes from current scientific literature, since patients older than 70 are often excluded from clinical randomized trials. In addition, information obtained from the methodologically well-designed studies does not always apply to elderly patients. Unfortunately, this may also translate in substandard cancer care delivered to this group as recently flagged by EUROCARE-5, the widest collaborative research project on cancer survival in Europe. The same scenario has been reported by the National Cancer Intelligence Network showing how in the UK elderly patients affected by solid tumor receive less surgery as compared to the younger counterpart. The difficulty in applying the “standard of care” more broadly needs to be searched in a combination of patients’ comorbidities, psychosocial issues, and physicians’ attitude. All these factors contribute to the challenge in the perioperative decision-making, eventually affecting the treatment outcomes. © Springer Nature Switzerland AG 2020
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