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Many special features are associated with the treatment of cancer in the elderly. Little research exists on antitumor and radiation treatments for the elderly, as most clinical trials have not included patients over the age of In radiotherapy, in turn, smaller dosages than usual may have been used. Current treatment practices are based on subgroup analyses of studies, or recommendations made by experts, and not necessarily on randomized trials.

In recent clinical studies patients generally no longer have upper age limits, but patients are selected according to their general condition, so that other diseases have been ruled out, and the activity of kidneys, liver, heart and lungs are within normal limits. Therefore, we are gradually also starting to accumulate data on the treatment of elderly cancer patients. Oncological treatments such as chemotherapy and radiotherapy generally cause more harm for the elderly than for the younger.

These harms are also more serious in elderly patients. If the patient does not have other diseases, the treatment plan may at least in the beginning be prepared in the same way as for younger patients. The effect of drug treatments and radiotherapy is likely to be the same regardless of age. Other diseases in the elderly—such as diabetes, vascular disease, and impaired renal function—increase the risk of infections, anemia, nausea, depression and exhaustion. A few weeks bedridden may impair the general condition of the elderly so that they might no longer fully recover.

To find the equilibrium between the benefits and disadvantages of the treatment of the elderly, over-treatment and under-treatment need to be balanced. Effective chemotherapy should be started in spite of the expected harms in the elderly patients, for example, in the treatment of aggressive lymphoid tissues if healing is possible on the basis of earlier data. If the patient does not have close friends or family, carrying out the treatment may be difficult or even impossible. The geriatric and psycho-social assessment made prior to treatment help in selecting proper therapy.

They are particularly essential when symptomatic treatment is selected. Dementia and memory disorders may prevent treatment because cancer treatment requires understanding and cooperation skills. The patient must also have a positive stand on the treatment, because no one can be treated against their will. The patient has the right to participate in the selection of the treatment method whenever there are alternatives, and also to refuse offered treatment. If the patient refuses active treatment, she or he will be offered good symptomatic treatment and follow-up.

Cancer diagnoses may cause deep depression in the elderly, which may result in a false impression of them giving up on their own health issues. The patient may refuse e. The average age of prostate cancer patients is about 70 years. Roughly one-third of prostate cancer diagnoses are given to patients over the age of Surgery requires the patient to be in better general condition than radiation therapy, and thus radiation therapy is often selected for treating elderly patients.

Metastatic prostate cancer, in turn, is treated with hormone therapy, which may keep cancer spread to the bones asymptomatic for many years. Chemotherapy treatments require the patient to be in fairly good general condition, so they are not suitable for very elderly or patients with multiple diseases. Hormone therapies do not result in sudden and severe harm, but may be associated with osteoporosis, sweating, loss of muscle tone and increased cardiovascular disease risk. Lung cancer is still one of the cancers with the worst prognosis, and smoking is its main risk factor.

Surgery is a curative treatment for early-stage lung cancer. It is, however, only rarely possible, and the poor functioning of the heart or lungs of the elderly patient may prevent the surgery. Local radiation therapy can be used to relieve the symptoms of lung cancer, regardless of age. Chemotherapy treatments for lung cancer are quite severe and their effectiveness weak, so they are rarely given to elderly patients.

In recent years, new biological medicines have become available on the market, and they are used in the treatment of certain rare types of lung cancer. The most common intra—abdominal cancer is colon cancer, which today has a good prognosis. Intestinal disorders are common in older people, and therefore they may be left unexamined. On the other hand, emphasis is currently placed on the active investigation of elderly patients with intestinal symptoms, because the risk of cancer increases significantly with age. The risks related to surgery of the abdominal cavity are significant.

Therefore, symptomatic treatment may be settled with in cases where patients have other serious illnesses, such as heart failure. Colon and rectal cancer surgery also improve the quality of life of the elderly patient, even if the surgery would not prevent the progression of metastases outside the intestine. Adjuvant treatments cannot be performed if the patient has other medical conditions and multiple other medications.

However, chemotherapy given as tablets may be suitable for the elderly patients with no heart disease. Chemotherapy treatments and biological drugs delaying cancer progression and relieving the symptoms may also be considered in elderly patients. It is important to always anticipate the potential harm for the heart or the kidneys. Furthermore, there is great heterogeneity and difficulty in predicting who will develop both medical and psychosocial long-term and late effects after treatment.

Improved rigorous databases and cohorts should be developed and supported to inform medical outcomes. Several QoL assessment tools exist, but few evaluate all the different aspects of QoL—psychological, social, physical and spiritual—[ 86 ], and few have been specifically validated in the breast cancer population [ 87 ]. In addition, due to lack of clinical interpretation or difficulty in application, QoL results are seldom applied in clinical practice [ 88 , 89 ]. To fill this gap, improved assessment or interpretation tools need to be developed.

Guidelines to aid interpretation of QoL results may help ensure that available QoL results are actually used in clinical decision-making [ 90 , 91 ]. In addition, as patients are discharged to primary care for follow-up and the survivorship period is prolonged, there is a need for better follow-up tools and guidance, for both patients and primary care physicians. Distance and online follow-up tools may provide solutions [ 92—94 ], and their development and use should be strongly encouraged.

Long-term follow-up is crucial since breast cancer has a very prolonged natural history. It does, however, pose important logistical issues and requires the implementation of new communication technologies allowing patients to directly provide their follow-up.

Side Effects of Cancer Treatment - National Cancer Institute

Research into all aspects of optimal patient management and survivorship is important worldwide, including low- and middle-income countries [ 95 , 96 ]. A major unmet need is the development of a specific QoL tool for advanced breast cancer patients to correctly ascertain the impact of new therapies. Furthermore, some advanced breast cancer patients, especially the HER2-positive subtype, can now live for 8 or 9 years and have specific survivorship issues that need close attention. Of paramount importance are issues of availability and access to care, high-quality guidelines and their implementation as well as adequate ongoing education and training of all oncologists.

These are issues common to the management of all malignancies and will not be discussed here. The research priorities identified by the panel of experts reflect the evolution of breast cancer management in the last few decades and emerging medical needs, with increasing importance placed in the management of metastatic breast cancer, individually tailored treatment, and survivorship. We acknowledge Vanessa Marchesi and Yuki Takahashi for coordinating the project and editing the article.


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PAF has received travel support from Roche and Pfizer and served on an advisory board for Pfizer uncompensated. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Editor's Choice.

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Surviving Stage 4 Breast Cancer: Is It Possible?

Table 1. Summary of research needs in breast cancer identified by the panel and suggested actions. Defining research priorities without biases: what is the optimal process? Search ADS. International variation in female breast cancer incidence and mortality rates. A systematic assessment of benefits and risks to guide breast cancer screening decisions. American Society of Clinical Oncology clinical practice guideline: update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer.

Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among , women in randomised trials. Effect of radiotherapy after breast-conserving surgery on year recurrence and year breast cancer death: meta-analysis of individual patient data for 10, women in 17 randomised trials. Effect of radiotherapy after mastectomy and axillary surgery on year recurrence and year breast cancer mortality: meta-analysis of individual patient data for women in 22 randomised trials.

Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about , women in US SEER cancer registries. SWOG S a phase III, randomized clinical trial of standard adjuvant endocrine therapy with or without chemotherapy in patients with one to three positive nodes, hormone receptor HR -positive, and HER2-negative breast cancer with recurrence score RS of 25 or less. West German Study Group Phase III PlanB Trial: first prospective outcome data for the gene recurrence score assay and concordance of prognostic markers by central and local pathology assessment.

Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. Biomarkers of radiation exposure: can they predict normal tissue radiosensitivity? Proteomics discovery of radioresistant cancer biomarkers for radiotherapy. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. A randomized trial MA. Fluorouracil, epirubicin, and cyclophosphamide with either docetaxel or vinorelbine, with or without trastuzumab, as adjuvant treatments of breast cancer: final results of the FinHer Trial.


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