ESMO handbook of cancer in the senior patient

1 Introduction 1 Defining the Elderly 1 Biology of Aging and Changes in Organ Function 1 Changes in Cognition 2 Cancer and Aging 3 Clinical Aspects 3 Further Reading 7 2 Cancer Epidemiology 8 Introduction 8 Population Demographics 8 Cancer Demographics 9 Society-Related Problems 11 Conclusions 12 Further Reading 12 3 Evaluation of the Senior Cancer Patient: Comprehensive Geriatric Assessment and Screening Tools for the Elderly 13 Introduction 13 Short Screening Tools 15 The Vulnerable Elders Survey 13 19 MGA Packages 19 Further Reading 20 4 Frailty in the Elderly 22 Frailty in the Elderly 22 The Impact of Frailty on CancerAssessment of Frailty 27 Conclusion 28 Further Reading 28 5 Surgical Treatment 29 Introduction 29 Indications for Surgery 29 Patients Selection 30 Outcomes 32 Survival 33 Palliation 33 Side Effects 34 Conclusion 34 Further Reading 35 6 Radiotherapy in the Elderly Cancer Patient 36 Indications for Radiotherapy in the Elderly 36 Side Effects of Radiotherapy in the Elderly (Acute and Late) 37 Efficacy and Outcome of Radiotherapy in the Aging 40 Palliative Setting: Toxicity and Efficacy Ratio 42 Curative Setting: Combinations of Chemotherapy and Radiotherapy 42 Selection Criteria for Radiotherapy in the Elderly 43 Conclusions 44 Further Reading 45 7 Hormonal Anticancer Treatment in the Senior Cancer Patient 46 Introduction 46 Breast Cancer 46 Prostate Cancer 50 Further Reading 56 8 Cytotoxic and Targeted Anticancer Treatment in the Senior Cancer Patient 57 Introduction 57 Chemotherapy in Senior Adults 57 Targeted Therapies in Senior Adults 61 Further Reading9 Treatment of Lymphoma in the Elderly Population 66 Introduction 66 Diagnosis and Prognosis 66 Treatment 68 Conclusions 70 Further Reading 70 10 Management of Myeloproliferative Diseases in Senior Patients 72 Diagnosis and Classification of Myeloproliferative Disorders 72 Treatment Strategies of MPD in the Senior Patient 76 Conclusions 80 Future Outlook 80 Further Reading 81 11 Myelodysplastic Syndromes in the Senior Patient 82 The Relevance of Myelodysplastic Syndromes in the Elderly 82 Classification and Risk Scoring in MDS 82 Age-Adjusted Models and Assessment in Elderly MDS Patients 85 Treatment Options in Elderly MDS Patients 86 Future Perspectives 90 Further Reading 90 12 Breast Cancer in the Senior Patient 92 Introduction 92 Early Breast Cancer 92 Metastatic Breast Cancer 95 Conclusions 97 Further Reading 97 13 Lung Cancer in the Elderly 98 Introduction 98 Early Non–Small Cell Lung Cancer in the Elderly 98 Advanced Non–Small Cell Lung Cancer in the Elderly 101 Small Cell Lung Cancer in the Elderly 106 Palliative Treatment in Elderly Lung Cancer Patients 107 Conclusion 107 Further Reading14 Colorectal Cancer 109 Introduction 109 Adjuvant Chemotherapy 109 Metastatic Disease 111 Conclusion 113 Further Reading 113 15 Prostate Cancer 114 Introduction and General Background 114 Treatment of Localized Prostate Cancer in Senior Adult Patients 116 Treatment of Metastatic Prostate Cancer in Senior Adult Patients 117 Conclusion 118 Acknowledgments 119 Further Reading 120 16 Bladder Cancer 121 Incidence and Mortality 121 Etiology and Risk Factors 121 Pathology 121 Natural History and Tumor Biology 122 Signs and Symptoms 122 Imaging, Cystoscopy, and Urinary Cytopathology 122 Staging 123 Treatment of NMIBC 124 Surgical Treatment 124 Radiotherapy 125 Organ-Sparing Treatments 126 Systemic Chemotherapy 126 Prognosis of BC 126 Follow-Up 127 Further Reading 127 17 Gynecological Cancer in the Senior Patient 128 Introduction 128 Cervical Cancer 128 Uterine CancerSpecial Types of Endometrial Malignancy 133 Vaginal Cancer 134 Vulvar Cancer 137 Ovarian Cancer, Fallopian Tube Cancer, and Primary Peritoneal Cancer 139 Conclusion 142 Further Reading 142 18 Head and Neck Cancer in the Elderly 143 Introduction 143 Surgery 143 Radiotherapy 144 Chemotherapy 145 Targeted Therapies 146 Conclusion 146 Further Reading 147 19 Renal Cell Cancer 148 Introduction 148 Surgery in the Senior Cancer Patient 149 Systemic Therapy of Metastatic Renal Cell Carcinoma in the Senior Cancer Patient 149 Patient-Focused Approach 153 Conclusion 156 Further Reading 156 20 Psychological Problems in Older Cancer Patients 157 Introduction 157 Depression 157 Anxiety 161 Conclusions 164 Further Reading 164 21 Social and Ethical Aspects 165 Introduction 165 Respect 167 Admiration 167 Attention 167 Information 168 ProtectionCare 169 Time 169 Caution 170 Freedom 171 Further Reading 171 22 The Role of the Multidisciplinary Team 172 Introduction 172 The Assessment of Age 173 Polypharmacy 175 Management of the Caregiver 176 Function of the Team 178 Conclusions and Perspectives 180 Further Reading