BOOK
Geriatric Oncology, An Issue of Clinics in Geriatric Medicine, E-Book
Harvey Jay Cohen | Arati V. Rao
(2016)
Additional Information
Book Details
Abstract
This issue of Clinics in Geriatric Medicine, devoted to Geriatric Oncology, is guest edited by Drs. Harvey J. Cohen and Arati V. Rao of Duke University Medical Center. Articles in this issue include: Cancer and Aging: General Principles, Biology and Geriatric Assessment; Cancer Screening in the Elderly; Cancer Survivorship: Management of Long-term Toxicities; Socioeconomic Considerations and Shared Care Models of Older Cancer Care; Palliative Care and Symptom Management; Management of Prostate Cancer in the Elderly; Management of Breast Cancer in the Elderly; Management of Lung Cancer in the Elderly; Colorectal Cancer in the Elderly; Myelodysplastic Syndrome and Acute Myeloid Leukemia in the Elderly; Chronic Lymphocytic Leukemia and Other Lymphoproliferative Disorders; and Monoclonal Gammopathies and Multiple Myeloma in the Elderly.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Geriatric Oncology\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Preface\r | vii | ||
| Cancer and Aging: General Principles, Biology, and Geriatric Assessment\r | vii | ||
| Cancer Screening in Older Adults\r | vii | ||
| Socioeconomic Considerations and Shared-Care Models of Cancer Care for Older Adults\r | vii | ||
| Palliative Care and Symptom Management in Older Patients with Cancer\r | vii | ||
| Long-term Toxicity of Cancer Treatment in Older Patients\r | viii | ||
| Management of Lung Cancer in the Elderly\r | viii | ||
| Management of Colorectal Cancer in Older Adults\r | viii | ||
| Management of Prostate Cancer in the Elderly\r | viii | ||
| Approach and Management of Breast Cancer in the Elderly\r | ix | ||
| Myelodysplastic Syndromes and Acute Myeloid Leukemia in the Elderly\r | ix | ||
| Chronic Lymphocytic Leukemia and Other Lymphoproliferative Disorders\r | ix | ||
| Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma in Older Adults\r | ix | ||
| CLINICS IN GERIATRIC MEDICINE\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| May 2016 | xi | ||
| August 2016 | xi | ||
| November 2016 | xi | ||
| RECENT ISSUES | xi | ||
| November 2015 | xi | ||
| August 2015 | xi | ||
| May 2015 | xi | ||
| Preface | xiii | ||
| Erratum | xv | ||
| Cancer and Aging | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| GENERAL PRINCIPLES | 2 | ||
| BIOLOGY OF CANCER AND AGING | 2 | ||
| Theories on Aging and Potential Impact on Cancer | 2 | ||
| Mutation accumulation | 2 | ||
| The antagonist pleiotropy | 3 | ||
| Disposable soma theory | 3 | ||
| Stem cells, aging, and cancer | 5 | ||
| Hyperfunction theory and role of metabolic pathways | 5 | ||
| THE ROLE OF AGE-RELATED BIOMARKERS IN CANCER | 5 | ||
| GERIATRIC ASSESSMENT IN OLDER PATIENTS WITH CANCER | 7 | ||
| Applications of Geriatric Assessment in Older Patients with Cancer | 7 | ||
| Predict treatment toxicity | 7 | ||
| Predict survival of older adults with cancer | 8 | ||
| Identify areas of vulnerability | 9 | ||
| Assist in clinical decision-making | 9 | ||
| Inclusion in clinical trials to provide a more accurate descriptor of the study population | 9 | ||
| Future Research Directions | 10 | ||
| SUMMARY | 10 | ||
| REFERENCES | 10 | ||
| Cancer Screening in Older Adults | 17 | ||
| Key points | 17 | ||
| INTRODUCTION | 17 | ||
| COLORECTAL CANCER SCREENING | 18 | ||
| LUNG CANCER SCREENING | 21 | ||
| PROSTATE CANCER SCREENING | 26 | ||
| BREAST CANCER SCREENING | 27 | ||
| CERVICAL CANCER SCREENING | 29 | ||
| SUMMARY | 30 | ||
| REFERENCES | 30 | ||
| Socioeconomic Considerations and Shared-Care Models of Cancer Care for Older Adults | 35 | ||
| Key points | 35 | ||
| GERIATRICS APPROACH TO CANCER CARE CAN IMPROVE THE DELIVERED VALUE | 35 | ||
| SOCIOECONOMIC CONSIDERATIONS OF PROVIDING HIGH-VALUE CANCER CARE | 36 | ||
| GERIATRIC ASSESSMENT AND TARGETED INTERVENTIONS ACROSS THE CANCER CARE CONTINUUM | 37 | ||
| ORGANIZATIONAL MODELS OF CANCER CARE | 39 | ||
| Primary Provider Model | 40 | ||
| Multidisciplinary Consultative Model | 40 | ||
| Geriatrics-Driven and Embedded Consultative Model | 40 | ||
| Screen and Refer Clinic Model | 41 | ||
| REFERENCES | 41 | ||
| Palliative Care and Symptom Management in Older Patients with Cancer | 45 | ||
| Key points | 45 | ||
| PALLIATIVE CARE IN GERIATRIC ONCOLOGY | 45 | ||
| SYMPTOM MANAGEMENT | 46 | ||
| ASSESSMENT AND MANAGEMENT OF PAIN | 46 | ||
| Management of Pain | 47 | ||
| Nonpharmacologic interventions | 48 | ||
| Pharmacologic interventions | 48 | ||
| Nonopioid therapy | 48 | ||
| Acetaminophen | 48 | ||
| Nonsteroidal antiinflammatory drugs | 48 | ||
| Opioid therapy | 48 | ||
| Opioid adverse effects | 50 | ||
| Adjuvant medications | 50 | ||
| ASSESSMENT AND MANAGEMENT OF NONPAIN SYMPTOMS | 51 | ||
| Fatigue | 51 | ||
| Management of fatigue | 51 | ||
| Nonpharmacologic interventions | 51 | ||
| Pharmacologic interventions | 51 | ||
| Delirium | 52 | ||
| Management of delirium | 53 | ||
| Long-term Toxicity of Cancer Treatment in Older Patients | 63 | ||
| Key points | 63 | ||
| INTRODUCTION | 63 | ||
| INTERACTION BETWEEN AGING, CANCER, CANCER TREATMENT, AND THEIR IMPACT ON FRAILTY | 64 | ||
| MEASURING FRAILTY AND GERIATRIC DEFICITS | 64 | ||
| THERAPY FOR ELDERLY PATIENTS WITH CANCER | 65 | ||
| CHRONIC TOXICITY FROM CANCER THERAPY | 67 | ||
| Cardiotoxicity | 67 | ||
| Emotional Effects (Depression, Anxiety) | 67 | ||
| Ototoxicity | 68 | ||
| Balance and Coordination | 68 | ||
| Effect on Muscle and Bone Health | 68 | ||
| Metabolic Syndrome | 68 | ||
| Secondary Malignancies | 69 | ||
| Sexual and Vaginal Dysfunction | 69 | ||
| Fatigue | 70 | ||
| Cognitive Impairment | 70 | ||
| EFFECT OF OTHER MODALITIES | 70 | ||
| Targeted Therapies | 70 | ||
| Long-term Toxicities of Radiation | 72 | ||
| Central nervous system | 72 | ||
| Neck and upper aerodigestive tract | 72 | ||
| Thorax | 72 | ||
| Gastrointestinal | 72 | ||
| SUMMARY | 73 | ||
| REFERENCES | 73 | ||
| Management of Lung Cancer in the Elderly | 81 | ||
| Key points | 81 | ||
| INTRODUCTION | 81 | ||
| Demographics and Scope of the Problem | 81 | ||
| Staging | 82 | ||
| PRINCIPLES OF MANAGEMENT | 82 | ||
| Early Stage Disease | 82 | ||
| Surgery for non–small cell lung cancer | 82 | ||
| Adjuvant chemotherapy in the elderly | 83 | ||
| Locally Advanced Non–small Cell Lung Cancer | 85 | ||
| Prospective trials in the elderly | 86 | ||
| Results from population databases | 86 | ||
| Advanced Disease: Management Principles | 87 | ||
| Importance of histology and molecular markers | 87 | ||
| Cytotoxic chemotherapy in advanced disease | 87 | ||
| Use of Targeted Therapy | 88 | ||
| Risk Stratification Using Geriatric Assessment | 90 | ||
| Patients’ Preferences and Understanding of Goals of Therapy | 91 | ||
| The Role of Palliative Care | 92 | ||
| SUMMARY | 92 | ||
| REFERENCES | 92 | ||
| Management of Colorectal Cancer in Older Adults | 97 | ||
| Key points | 97 | ||
| INTRODUCTION | 97 | ||
| COLORECTAL CANCER SCREENING | 98 | ||
| SURGERY | 98 | ||
| Alternatives to Surgery | 98 | ||
| Colonic stents | 99 | ||
| Radiofrequency ablation | 99 | ||
| RECTAL CANCER | 99 | ||
| SYSTEMIC THERAPY FOR COLORECTAL CANCER | 99 | ||
| Adjuvant Chemotherapy for Older Adults | 99 | ||
| The fluoropyrimidines (5-fluoruracil and capecitabine) | 99 | ||
| Oxaliplatin plus a fluoropyrimidine | 101 | ||
| Tolerance of oxaliplatin in the elderly | 103 | ||
| Summary: Tailoring Adjuvant Therapy for the Older Adult with Colorectal Cancer | 103 | ||
| Very fit older adults | 103 | ||
| Moderately fit older adults | 103 | ||
| Unfit older adults | 103 | ||
| Advanced/Metastatic Disease in Older Adults | 104 | ||
| Resectable | 104 | ||
| Borderline resectable | 104 | ||
| Palliative treatment | 104 | ||
| Systemic Therapy for Older Adults with Metastatic Colorectal Cancer | 104 | ||
| Combination cytotoxic chemotherapy | 104 | ||
| Oxaliplatin plus fluoropyrimidine | 104 | ||
| Irinotecan plus 5-Fluoracil | 105 | ||
| Minimizing toxicity with chemotherapy | 105 | ||
| Intermittent oxaliplatin administration | 105 | ||
| Omission of 5-fluoracil bolus | 105 | ||
| Biologic agents | 106 | ||
| The vascular endothelial growth factor therapies | 106 | ||
| The epidermal growth factor receptor–targeted agents | 106 | ||
| Regorafenib, a multikinase inhibitor | 107 | ||
| Summary: Tailoring Therapy for the Older Adult with Metastatic Colorectal Cancer | 107 | ||
| Very fit older adults | 107 | ||
| Moderately fit older adults | 107 | ||
| Unfit older adults | 107 | ||
| REFERENCES | 107 | ||
| Management of Prostate Cancer in the Elderly | 113 | ||
| Key points | 113 | ||
| INTRODUCTION | 113 | ||
| CLINICALLY LOCALIZED PROSTATE CANCER | 114 | ||
| Deciding Who Needs to be Treated | 114 | ||
| Estimating Life Expectancy | 115 | ||
| Expectant Management: Watchful Waiting or Active Surveillance? | 117 | ||
| Deciding on What Type of Treatment, If Treatment is Necessary | 119 | ||
| Radical prostatectomy in the elderly | 119 | ||
| Radiation therapy in the elderly | 119 | ||
| Thermal ablation in the elderly | 120 | ||
| Focal therapy | 120 | ||
| ADVANCED PROSTATE CANCER | 120 | ||
| Locally Advanced Prostate Cancer: Sequencing Multimodality Treatment in Elderly Patients | 120 | ||
| Metastatic Prostate Cancer in the Elderly | 121 | ||
| Androgen deprivation therapy | 121 | ||
| Castrate-Resistant Prostate Cancer | 122 | ||
| Secondary hormonal manipulation | 123 | ||
| Immunotherapy | 123 | ||
| Radioisotopes | 124 | ||
| Cytotoxic chemotherapy | 124 | ||
| Sequencing treatments in castrate-resistant prostate cancer | 124 | ||
| SUMMARY | 126 | ||
| REFERENCES | 126 | ||
| Approach and Management of Breast Cancer in the Elderly | 133 | ||
| Key points | 133 | ||
| INTRODUCTION | 133 | ||
| CHALLENGES IN CARING FOR OLDER PATIENTS WITH BREAST CANCER | 135 | ||
| STAGING | 137 | ||
| EARLY STAGE BREAST CANCER (STAGE 0–3) | 138 | ||
| Surgery and Primary Endocrine Therapy | 138 | ||
| Radiation Therapy | 139 | ||
| Systemic Therapy | 141 | ||
| Treatment considerations | 141 | ||
| Endocrine therapy | 142 | ||
| Chemotherapy | 143 | ||
| Biological agents | 144 | ||
| METASTATIC DISEASE | 144 | ||
| FOLLOW-UP AND SURVIVORSHIP | 146 | ||
| SUMMARY | 146 | ||
| REFERENCES | 147 | ||
| Myelodysplastic Syndromes and Acute Myeloid Leukemia in the Elderly | 155 | ||
| Key points | 155 | ||
| MYELODYSPLASTIC SYNDROMES | 155 | ||
| Diagnosis and Work-up | 156 | ||
| Risk Stratification: Disease Characteristics | 156 | ||
| Risk Stratification: Patient Characteristics | 156 | ||
| Treatment | 157 | ||
| Unresolved Questions for Older Adults with Myelodysplastic Syndromes | 160 | ||
| ACUTE MYELOID LEUKEMIA | 160 | ||
| Diagnosis | 160 | ||
| Treatment | 161 | ||
| Tumor Biology | 161 | ||
| Review of Elderly-specific Clinical Trial Data | 162 | ||
| Risk Stratification | 165 | ||
| Unanswered Questions for Older Adults with Acute Myeloid Leukemia | 167 | ||
| SUMMARY | 169 | ||
| REFERENCES | 169 | ||
| Chronic Lymphocytic Leukemia and Other Lymphoproliferative Disorders | 175 | ||
| Key points | 175 | ||
| CHRONIC LYMPHOCYTIC LEUKEMIA | 175 | ||
| Epidemiology | 175 | ||
| Spectrum of Disease and Prognosis | 176 | ||
| Monitoring and Therapy | 177 | ||
| OTHER COMMON NON-HODGKIN LYMPHOMAS | 180 | ||
| Epidemiology | 180 | ||
| Diagnosis and Staging | 180 | ||
| Monitoring and Therapy | 181 | ||
| Diffuse large B-cell lymphoma | 181 | ||
| Mantle cell lymphoma | 183 | ||
| Follicular lymphoma | 183 | ||
| SUMMARY | 184 | ||
| REFERENCES | 184 | ||
| Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma in Older Adults | 191 | ||
| Key points | 191 | ||
| INTRODUCTION AND EPIDEMIOLOGY | 191 | ||
| BIOLOGY AND CAUSE | 192 | ||
| CLINICAL PRESENTATION OF MULTIPLE MYELOMA | 193 | ||
| EVALUATION AND DIAGNOSIS | 193 | ||
| STAGING AND PROGNOSIS | 196 | ||
| MANAGEMENT AND TREATMENT | 198 | ||
| SIDE EFFECTS AND SUPPORTIVE CARE | 200 | ||
| SUMMARY | 202 | ||
| REFERENCES | 202 | ||
| Index | 207 |