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Elderly Cancer Is Different!

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Elderly cancer patients, people 70 years of age or older, have difficulty dealing with toxicity. In general, older cancer patients develop side effects more readily than younger people do.

According to the research linked and excerpted below, elderly cancer patients develop more adverse events when given standard-of-care doses of chemo while, at the same time, do better when standard doses are reduced.

Any board certified oncologist can prescribe any dose he/she thinks is best to any cancer patient. This is how the FDA works in the United States.

This shouldn’t come as a surprise to anyone. Especially cancer survivors themselves. I myself developed a host of short, long-term and late stage side effects when I underwent cancer therapy in my thirties. 

The issue is all about quantity versus quality of life. Not only may the elderly cancer patient feel differently that you do about this trade-off, but their cancer may be slower growing and require less toxicity in order to manage it.

The “maximum tolerated dose” that the average clinical trial determines for the type and stage of cancer in question will, in all probability be different for elderly patients simply because they are underrepresented in the average clinical trial.

What are the typical adverse events that occur to elderly cancer patients?

  1. Fatigue: Feeling tired or exhausted is one of the most common side effects of cancer and its treatment.
  2. Nausea and vomiting: Chemotherapy and radiation therapy can cause nausea and vomiting, which can be particularly distressing for elderly patients.
  3. Decreased appetite and weight loss: Cancer and its treatment can affect appetite and lead to unintentional weight loss.
  4. Weakened immune system: Cancer and certain cancer treatments can weaken the immune system, making elderly patients more susceptible to infections.
  5. Anemia: Chemotherapy and cancer itself can lead to a decrease in red blood cells, causing anemia and resulting in fatigue and weakness.
  6. Cognitive changes: Some elderly cancer patients may experience cognitive changes, such as confusion or memory problems, which can be exacerbated by certain treatments.
  7. Pain: Cancer-related pain can be a significant issue for elderly patients, affecting their quality of life.
  8. Digestive problems: Chemotherapy and radiation therapy can cause digestive issues such as diarrhea, constipation, or mucositis (inflammation of the mucous membranes).
  9. Skin changes: Radiation therapy can cause skin reactions, such as redness, irritation, or blistering, in the treated area.
  10. Cardiovascular issues: Some cancer treatments, particularly certain chemotherapy drugs, can affect the heart and increase the risk of cardiovascular problems in elderly patients.
  11. Bone health: Certain cancer treatments can weaken the bones and increase the risk of fractures in elderly patients.
  12. Psychological effects: Elderly cancer patients may experience psychological distress, anxiety, depression, or mood changes due to their diagnosis and treatment.

It is normal to think that “more is better” when it comes to cancer therapy. But it is not in many cases. Elderly cancer care is one such case.

In addition to FDA approved conventional cancer therapies such as chemotherapy, radiation and surgery, consider evidence-based non-conventional, non-toxic therapies such as

  • nutrition
  • exercise
  • nutritional supplementation

to name a few examples. You may find that the elderly cancer patient lives a much higher quality of life as well as a greater quantity of life by taking a “less is more” approach to toxicity.

If you have any questions about either conventional or non-conventional cancer therapies feel free to email me at David.PeopleBeatingCancer@gmail.com

Good luck,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Primary Treatment Modification and Treatment Tolerability Among Older Chemotherapy Recipients With Advanced Cancer

“What is the association between primary treatment modification (eg, primary dose reduction and schedule modification) and tolerability outcomes in older adults with advanced cancer?…

Findings  In this cohort study of 609 older adults with advanced cancer who were starting a new chemotherapy regimen in the community oncology setting, patients who had primary treatment modification had a 15% reduced risk of serious clinician-rated toxic effects and a 20% reduced risk of patient-reported functional decline compared with those who received standard doses…

Older adults are disproportionately underrepresented in cancer trials that are used to establish treatment guidelines.13 Hence, the reported risks and benefits of cancer treatment are based on clinical trials conducted in younger and healthier patients.4,5 This underrepresentation results in uncertainties about the standard-of-care treatments for older patients, including treatment safety and efficacy for older adults who have aging-related conditions…

Older adults with cancer are generally considered to be more vulnerable to the adverse effects of cytotoxic chemotherapy- (eg, poor tolerability) compared with younger patients,6 due to disabilities, deterioration in organ function, or other geriatric impairments (eg, impaired cognition) that may add to treatment toxicity.68Despite these vulnerabilities, older adults are often given aggressive chemotherapeutic agents with a high risk of toxicity (eg, febrile neutropenia, fatigue, and neuropathy), which can ultimately lead to treatment delays and poor cancer control.6,9

Although aggressive cytotoxic therapies have the potential to extend life among older adults with advanced cancer and aging-related conditions, they also can cause serious adverse events that may worsen quality of life.6

Due to unclear data on treatment decision-making in older adults with advanced cancer, oncologists may modify treatment during the first cycle of chemotherapy (ie, primary treatment modification) by

  • dose reduction,
  • schedule alteration,
  • or use of less toxic regimens to reduce the potential side effects of systemic chemotherapy.10

Conclusions- In this cohort study of older adults with advanced cancer who were initiating new chemotherapy in the community oncology setting, we observed that patients undergoing primary treatment modification experienced improved tolerability, indicated by

  • a reduced risk of clinician-rated grade 3 to 5 treatment toxic effects
  • and patient-reported functional decline,

compared with those receiving standard doses. In addition, our findings illustrate that primary treatment modification improved patient tolerability without compromising treatment efficacy, as assessed through a composite adverse outcome measure…”





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