CANCER-CHEMOTHERAPY IN OLDER ADULTS - A TOLERABILITY PERSPECTIVE

The incidence of cancer increases with age, Since the geriatric popula tion is growing, we will be confronted with an increasing number of pa tients with cancer who are >65 years of age, The purpose of this revie w is to address the use of cancer chemotherapy in older persons with r espect to its tolerability, We performed a review of the literature us ing 'Medline' and the bibliographies of pertinent publications. Inform ation about cancer treatment in older adults was extracted with partic ular attention to chemotherapy-related toxicity in patients aged >65 y ears, Comorbid disease. polypharmacy/drug interactions, psychosocial i ssues and age-related physiological changes are major issues In caring for older patients with cancer. Since older individuals may have a gr eater number or comorbid illnesses. treatment should be initiated on t he basis of physiological rather than chronological age, Comparative s tudies show that chemotherapy-related toxicity: is similar in older an d younger patients, with the exception of haematological toxicity, whi ch may he more severe in older patients, and cardiotoxicity, which is more frequent in the elderly, Other evidence suggests that gastrointes tinal and neurotoxicities may also be mure severe in older individuals , The dosages of chemotherapeutic agents that are primarily renally ex creted may require adjustment in older patients. Haematological reserv e is decreased in older individuals, and drugs that cause myelosuppres sion must be used with care. The use of haemopoietic growth factors in geriatric patients is currently being investigated.