Hematopoietic growth factors in the older cancer patient

Aging is associated with a progressive decline in the functional reserve of multiple organ systems, which may lead to enhanced susceptibility to stres s such as that caused by cancer chemotherapy. Myelodepression is the most c ommon and the most commonly fatal complication of antineoplastic drug thera py and may represent a serious hindrance to the management of cancer in old er individuals. This is already a common and pervasive problem and promises to become more so. Currently 60% of all neoplasms occur in persons aged 65 years and older, and this percentage is expected to increase as the popula tion ages. This well-known phenomenon, sometimes referred to as squaring or the age pyramid, is caused by the combination of an increasing life expect ancy and a decreasing birth rate. This article explores the use of hematopo ietic growth factors in the older cancer patient after reviewing the influe nce of age on hemopoiesis and chemotherapy-related complications. The issue is examined in terms of effectiveness and cost. An outline of the assessme nt of the older cancer patient is provided at the end of the chapter as a f rame of reference for clinical decisions. (C) 2001 Lippincott Williams & Wi lkins, Inc.