Undertreatment may contribute to deaths of older cancer patients
April 1, 2011|Hematology and Oncology
Author and Disclosure Information
From the 6th Annual Community Oncology Conference
Juggling clinical advances and sweeping changes in practice
The following reports are based on presentations at the 6th Annual Community Oncology Conference held in Las Vegas, February 25–26, 2011. Additional presentations will be featured in a supplement to an upcoming issue of Community Oncology. The conference is presented annually by this journal.
Refining chemotherapy
Oncologists should refer to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines to help tailor chemotherapy in patients aged 65 years or older. Such recommendations include, for example, that the first dose be adjusted for renal function and that prophylactic filgrastim (Neupogen) or pegfilgrastim (Neulasta) be given to patients receiving moderately toxic regimens.
Oncologists should refer to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines to help tailor chemotherapy in patients aged 65 years or older. Such recommendations include, for example, that the first dose be adjusted for renal function and that prophylactic filgrastim (Neupogen) or pegfilgrastim (Neulasta) be given to patients receiving moderately toxic regimens.
“Some form of geriatric assessment should be done in all patients aged 70 and older to estimate life expectancy and risk of chemotherapy toxicity,” Dr. Balducci further noted. “And of course, when you can, you should use safer agents.”
Older patients today are likely to be taking multiple medications for other conditions, which can be problematic when it comes to their chemotherapy, especially given the increasing use of oral agents. Here, oncologists can refer to the STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria, which enable identification of unnecessary or redundant medications a patient may be taking (Int J Clin Pharmacol Ther 2008;46:72−83). “These criteria are very helpful to manage the polypharmacy,” he said.
Dr. Balducci is a consultant for Cephalon and serves on the speakers bureau for Amgen, Cephalon, Novartis, and sanofi-aventis U.S.
