Publication details
Treatment in the Elderly
| Authors | |
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| Year of publication | 2017 |
| Type | Chapter of a book |
| MU Faculty or unit | |
| Citation | |
| Description | Older age is the major risk factor for cancer development and the steadily rising global cancer burden is directly linked to the growing number of the elderly population. In the United States, the proportion of squamous cell carcinoma of the head and neck (SCCHN) patients over 65 is estimated to increase from 54 % in 2010 up to 66 % by 2030. However, chronological age does not always correlate with biological parameters to reliably predict life expectancy, functional reserve and the risk of treatment side effects in an individual. Thus, geriatric assessment tools were developed to differentiate between the fit and frail senior persons and guide treatment decisions. According to the recommended two-step approach, geriatric screening tests (e.g. G8 or Flemish version of the Triage Risk Screening Tool) are used to select patients further requiring a full evaluation. A comprehensive geriatric assessment, which is otherwise time-consuming and not necessary in every case, evaluates functional status, comorbidities, medications, cognition, psychological status, nutrition and social support. Despite the epidemiological significance, older adults have been underrepresented in prospective trials, which hampers the applicability of existing results to clinical practice. Nevertheless, growing evidence suggests benefits of treating older patients according to their biological and not chronological age. In recurrent and/or metastatic SCCHN, treatment goals aim primarily at symptom palliation and maintaining a good quality of life. Most patients do not qualify for surgery or irradiation and are thus considered for a systemic approach or supportive care only. Currently, the platinum (cisplatin or carboplatin)/5-fluorouracil/cetuximab (EXTREME) regimen is the approved first-line systemic treatment for fit patients. Retrospective data indicate that older adults treated with chemotherapy yield outcomes comparable to their younger counterparts, albeit at the cost of increased toxicity. Taken together, fit elderly patients can be treated according to the EXTREME protocol but the exact role of targeted agents in this subgroup remains to be defined. |