The overall management of rectal cancer has been dramatically reshaped in the last decades; several advancements should be reassessed when dealing older patients, representing the largest part of those who are affected by rectal cancer. Why this collaborative work is needed The management of rectal cancer is multidisciplinary: numerous advancements have been proposed recently, but only few of them have been validated for older patients.
Elderly | tanavofywe.tk
Despite the evidence that cancer is a disease of the elderly, very little level 1 evidence on its treatment is available since patients older than 70 are most frequently excluded from clinical randomized trials Zulman et al. Unfortunately, this may also translate into a substandard cancer care. 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 [iv].
Worse oncologic outcomes in the elderly population are mostly related to suboptimal treatments. The chain of events is likely to start from the health care providers who assess the patients in the first place. It has been reported as primary care physicians Delva et al. But, even if elderly patients are referred to a specialist, a similar age discrimination is likely to be noticed once again. Scientific Societies and working groups have been developing standardized pathways to diagnose, treat and often cure rectal cancer.
A thorough reassessment of this expertise by the proposed dedicated task-force will assist clinicians to gain a broad outlook of the multiple facets of rectal cancer care when diagnosed to an elderly patient. Good general condition and muscle strength, independence, as well as controlled diabetes and blood pressure can decisively work in favor of active treatment, if the patient is for example about to have a large operation of the abdominal cavity or lungs, and removing the cancer completely would be possible.
Even though a patient is very old and has other diseases, early-stage cancer can often be operated. Radiation and medical treatments provided after surgery reduce the risk of cancer spreading. These adjuvant treatments may cause temporary harms, but in spite of them it is easier for elderly patient to live with other illnesses without metastatic cancer. Many special features are associated with the treatment of cancer in the elderly.
Little research exists on antitumor and radiation treatments for the elderly, as most clinical trials have not included patients over the age of In radiotherapy, in turn, smaller dosages than usual may have been used.
Current treatment practices are based on subgroup analyses of studies, or recommendations made by experts, and not necessarily on randomized trials. In recent clinical studies patients generally no longer have upper age limits, but patients are selected according to their general condition, so that other diseases have been ruled out, and the activity of kidneys, liver, heart and lungs are within normal limits. Therefore, we are gradually also starting to accumulate data on the treatment of elderly cancer patients.
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Oncological treatments such as chemotherapy and radiotherapy generally cause more harm for the elderly than for the younger. These harms are also more serious in elderly patients. If the patient does not have other diseases, the treatment plan may at least in the beginning be prepared in the same way as for younger patients.
The effect of drug treatments and radiotherapy is likely to be the same regardless of age. Other diseases in the elderly—such as diabetes, vascular disease, and impaired renal function—increase the risk of infections, anemia, nausea, depression and exhaustion. A few weeks bedridden may impair the general condition of the elderly so that they might no longer fully recover.
To find the equilibrium between the benefits and disadvantages of the treatment of the elderly, over-treatment and under-treatment need to be balanced. Effective chemotherapy should be started in spite of the expected harms in the elderly patients, for example, in the treatment of aggressive lymphoid tissues if healing is possible on the basis of earlier data.
If the patient does not have close friends or family, carrying out the treatment may be difficult or even impossible. The geriatric and psycho-social assessment made prior to treatment help in selecting proper therapy. They are particularly essential when symptomatic treatment is selected. Dementia and memory disorders may prevent treatment because cancer treatment requires understanding and cooperation skills.
The patient must also have a positive stand on the treatment, because no one can be treated against their will. The patient has the right to participate in the selection of the treatment method whenever there are alternatives, and also to refuse offered treatment. If the patient refuses active treatment, she or he will be offered good symptomatic treatment and follow-up. Cancer diagnoses may cause deep depression in the elderly, which may result in a false impression of them giving up on their own health issues. The patient may refuse e.
The average age of prostate cancer patients is about 70 years. Roughly one-third of prostate cancer diagnoses are given to patients over the age of Surgery requires the patient to be in better general condition than radiation therapy, and thus radiation therapy is often selected for treating elderly patients.
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Metastatic prostate cancer, in turn, is treated with hormone therapy, which may keep cancer spread to the bones asymptomatic for many years. Chemotherapy treatments require the patient to be in fairly good general condition, so they are not suitable for very elderly or patients with multiple diseases. Hormone therapies do not result in sudden and severe harm, but may be associated with osteoporosis, sweating, loss of muscle tone and increased cardiovascular disease risk.
Lung cancer is still one of the cancers with the worst prognosis, and smoking is its main risk factor. Surgery is a curative treatment for early-stage lung cancer. It is, however, only rarely possible, and the poor functioning of the heart or lungs of the elderly patient may prevent the surgery. Local radiation therapy can be used to relieve the symptoms of lung cancer, regardless of age. Chemotherapy treatments for lung cancer are quite severe and their effectiveness weak, so they are rarely given to elderly patients.
In recent years, new biological medicines have become available on the market, and they are used in the treatment of certain rare types of lung cancer. The most common intra—abdominal cancer is colon cancer, which today has a good prognosis. Intestinal disorders are common in older people, and therefore they may be left unexamined. On the other hand, emphasis is currently placed on the active investigation of elderly patients with intestinal symptoms, because the risk of cancer increases significantly with age.
The risks related to surgery of the abdominal cavity are significant. Therefore, symptomatic treatment may be settled with in cases where patients have other serious illnesses, such as heart failure. Colon and rectal cancer surgery also improve the quality of life of the elderly patient, even if the surgery would not prevent the progression of metastases outside the intestine. Adjuvant treatments cannot be performed if the patient has other medical conditions and multiple other medications. However, chemotherapy given as tablets may be suitable for the elderly patients with no heart disease.
Chemotherapy treatments and biological drugs delaying cancer progression and relieving the symptoms may also be considered in elderly patients. It is important to always anticipate the potential harm for the heart or the kidneys. Breast cancer in the elderly is rarely a biologically aggressive subtype, yet nevertheless the mortality rate of breast cancer in older people is greater than in younger people. One reason for this is the fact that the cancer has often advanced more widely in elderly patients at the moment it is diagnosed. In breast cancer, the prognosis is especially good if it is diagnosed at an early stage.
Breast cancer can usually be operated normally, regardless of age. Armpits are examined by sentinel node scanning, which poses no risk to the patient. A breast can be removed even under local anesthesia.
Breast-sparing surgery is usually supplemented by radiotherapy. In the past, it was a customary to remove the entire breast of an elderly patient on a much more lightly basis in order to spare them from radiotherapy. Today, radiation therapy may be provided in a short, three-week treatment cycle, instead of the previous five-week cycle.
Age and Cancer
Active Breathing Control technique also enables minimizing the radiation dose received by the heart. Today, the advantages and disadvantages of mastectomy and breast-saving surgery can be contemplated together with the elderly patient. Adjuvant treatments are also used after the surgery, which reduces the risk of breast cancer recurrence.
A five-year hormonal drug therapy with tablets can usually be started for older patients. If the breast cancer has spread, hormonal drugs can slow down its progression and relieve symptoms. There are a number of different chemotherapies, and they are administered individually. Key points Age significantly increases the risk of cancer. In elderly people, other lifestyle- associated risks will also accumulate. Early-stage cancer can often be operated even though a patient is elderly. There is only little research data on antitumor and radiation treatments of elderly patients.