Complications in the systemic treatment in elderly patients. Neutropenia as limiting factor

Abstract

The ageing of the population, increasing life expectancy and cancer morbidity make the systemic treatment of patients over the age of 65 common issue in medical oncology. Older patients constitute a very heterogeneous group due to the differences in their general condition, organ reserves, comorbidities and the polypharmacy as its consequence. In the treatment planning in geriatric oncology it is crucial to select those patients who are able to tolerate intensive treatment e.g. induction chemotherapy or adjuvant treatment (in those with expected longsurvival) and patients in whom less aggressive treatment or best supportive care is the most beneficial approach. The ageing process has been associated with changes in pharmacodynamics and pharmacokinetics of the cancer medications resulting in their higher toxicity in elderly. Myelotoxicity is very common and older age is one of the most important risk factors for severe neutropenia and febrile neutropenia. It has been exhibited that comorbid conditions in elderly independently increase the risk of febrile neutropenia. It should also be noticed that in caseof curative treatment myelosupression and its complications may result in chemotherapy dose reductions, treatment interruptions, decreasing overall treatment efficacy. For these reasons the assesment of risk of myelotoxicity and its complications as well as the appropiate use of granulocyte-colony stimulating factors in elderly patientsis very important in clinical practice.