Treatment and Management of Cancer in the Elderly PDF

Preface

Cancer is a disease of aging. Twenty percent of the population in the United States is projected to be aged 65 years and older by year 2030 and the majority of cancers will occur in this age group. Cancer risk increases with age as a result of cumulative genetic, molecular, and biologic changes. In most affluent nations great progress in the prevention and treatment of infectious and childhood disease has led to major increases in longevity, but such gains have come with an increase in the number of people with cancer. The greatest burden of cancer occurs in men and women aged 65 years and older, a population that suffers excess morbidity, reduced quality of life, and economic disparity due to chronic disease. Advancements in the diagnosis and treatment of cancer have resulted in significant reductions in morbidity and improved quality of life, yet these advances have not been adequately shared with the older population. Until recently, cancer in the elderly received little attention. Screening and early detection were offered less frequently to older patients than their younger counterparts. Even now with the greater awareness of the benefits of screening, elders are less likely to receive mammography, colonoscopy and Papanicolaou smears—all procedures associated with decreased mortality—when compared to younger patients. Older patients are also less likely to be offered curative surgery, adjuvant treatment, and treatment for metastases. Some of these decisions in elders are appropriate but in many instances, such undertreatment is representative of long held and mistaken age biases that ultimately lead to poorer outcomes and shortened survival.

We know much more now about the aging process than we did in the past. Shifting demographics, major advances in medical treatment, and improved health and longevity in persons past middle age have led to a gradual transition from a palliative approach to disease management, to an emphasis on curative treatment. Moreover, prevention and risk-reduction for many cancers is now feasible. The awareness of the burden of cancer among elders has led to increased research and support from federal agencies, academic and private institutions, and other public health organizations. In addition to relaxation of eligibility criteria that previously restricted the inclusion of older patients in clinical trials, new trials focusing on the elderly and which include detailed functional and quality of life assessments are now in progress. Data from clinical trials is mandatory for providing optimal care to elders with cancer, and for factoring in the effects of comorbidity and loss of function on cancer treatment. This book brings together a compendium of knowledge on cancer in the elderly that we believe will be useful for health care professionals, researchers, educators, policy makers, and students of public health and preventive medicine.

Treatment and Management of Cancer in the Elderly addresses major and fundamental issues and problems encountered in delivering cancer care to elderly patients. This compendium builds on our first edition of Cancer in the Elderly with an expanded base of knowledge and information on new and current approaches for optimizing cancer care, the results of multi-disciplinary treatments, and strategies for more effective control of cancer in the elderly. The complexity of cancer management is elucidated in chapters that incorporate multi-disciplinary approaches to cancer treatment. The text could be thought of in four parts. Part one includes chapters on epidemiology, the major treatment modalities of surgery, radiation and chemotherapy, and a new chapter on elder law. Part two includes chapters on hematologic malignancy and part three includes chapters on solid tumors. These chapters on sitespecific cancers examine the best treatment practices and present results from prevention, adjuvant, neo-adjuvant, and treatment trials. When appropriate, treatment sections on surgery, radiation therapy, chemotherapy, and other modality therapies are included in these chapters. Part four includes chapters on quality of life, geriatric assessment, and comorbidity, and new chapters on exercise, nutrition, management of the frail elderly, end-of-life care, and family support.

The editors dedicate this work to physicians, nurses, other health professionals, and scientists who will utilize the knowledge gained to improve cancer care management in elderly patients. We also dedicate this work to those elderly cancer patients, their family members, and supporting teams who struggle each day to optimize cancer care with human compassion and dignity.