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23 Cards in this Set
- Front
- Back
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do peripheral blood counts decrease with age?
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no
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describe change in reserve capacity in older pts
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diminished reserve capacity
Normal CBC but reserves are lower |
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most common cause of anemia in older pts
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iron deficiency (20%)
Anemia of chronic disease or inflammation can be just as prevalent depending on the population |
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Other common causes of anemia in older patients
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Kidney disease, B12 or folate deficiency
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Clinical Associations of anemia in elderly
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incr mortality, incr cardiac disease, decr muscle mass/strength, incr disability, incr falls and fractures, assoc with cognitive impairment
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A 76 yo woman is seen in clinic w/ a microcytic anemia and a Hg of 11, you should:
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refer her for a colonoscopy
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What may be the first sign of an underlying serious illness
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microcytic anemia
- may also be an independant cause of morbidity and mortality |
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The majority of cancer patients are of what age?
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>65 yo
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Incidence of most malignancies increase with age because
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-longer duration of carcinogen exposure
-decreased DNA repair ability -Increased genomic instability -decreased tumor supressor activity -decreased immune surveillance |
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Does age play a role in Tx of malignancies?
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yes, older adults can experience incr toxicity, but they can benefit from aggressive Tx and can tolerate it fairly well
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Patients over 65 are how many times more likely to dies of disease compared to younger ones?
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16 times.
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Does age affect survival in hematologic malignancies?
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yes. incre age correlates with decr survival
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Multi focal disparity for older cancer pts
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other factors affecting prognosis like physiologic changes, impairment in fxn and co morbidities
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Research bias in Cancer research involving older pts
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only 1/3 of pts on NCI sponsored trials were >65
very few >75 are enrolled in clinical trials poor generalizability due to selection bias |
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Treatment bias in older adults
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"you dont need to worry about this screening at your age"
"We dont need to treat this aggressively" "Doctor, what do you mean I should take chemo? im 79 yrs old!" |
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Should chemo dosing Tx be decreased in an 80 yo pt?
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no, dose attenuation has resulted in inferior outcomes
- applied to agressive tumor types |
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Why are older adults treated differently
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Concern for toxicity, question effectiveness of Tx, Lack of referral, Social Marginalization, Pt preference, Lack of clinical trial data
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Age related changes in tumor biology (unfavorable)
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Acute Leukemias:
-More MDR1 -unfavorable cytogenetics -prior MDS -more Ph+ (ALL) |
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Age related changes in tumor biology (favorable)
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Breast Cancer
-more ER+ -lower proliferative rates etc |
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Age related changes in Pharmacology
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-decreased intestinal absorption
-Decline in renal excretion -Altered metabolism by Cytochrome P450 All things affecting boiavailability, toxicity and activation or elimination in one way or another |
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Treatment decisions in elderly patients based on:
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Characteristic of Pt: life expectancy, reserve capcity (estimated by fxnl status and comorbidity)
Characteristics of tumor: agressive vs indolent, tumor biology Characteristics of Tx: efficacy vs toxicity |
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Comprehensive Geriatric Assessment
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function, comorbidity, Socioeconomic status, , geriatric syndromes, Polypharmacy, Nutrition
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Emerging Guidelines to minimize toxicity in elderly pts
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Myelosupression: prophylactic growth factor
Renal: considder adj of renally excreted drugs based on GFR Mucositis: nutritional support early hospitalization is dysphagia, diarrhea develops Neurotoxicity: monitor neurotoxic regimens closely and consider alt meds Cardia: careful pre tx assessment avoid cardiotoxic regimens if possible |
