Studies show elderly can tolerate strong cancer drugs

By Emma Ross

 Meeting of the European Society of Medical Oncology, October 20, 2002

Many elderly patients can tolerate powerful cancer drugs better than doctors think, according to research presented Sunday.

Half of all cancers are diagnosed after the age of 65 and experts predict that 30 years from now, elderly people will comprise 70 percent of cancer diagnoses.

However, there is no clear treatment strategy for cancer in the elderly. Most cancer drug trials exclude patients over 70 and doctors are subsequently reluctant to give the medications to older patients because they fear the side effects may be too harsh for them.

Studies presented Sunday at a meeting of the European Society of Medical Oncology indicate that, at least in some cancers, elderly patients can be treated more aggressively.

``Elderly patients must be offered the same treatment options as younger patients, even if treatment of the elderly is less cost-effective,'' said Dr. Silvio Monfardini, president of the International Society of Geriatric Oncology who was not connected with any of the studies. ``It is wrong and unethical to discriminate against a patient because of their age.''

``The whole problem of cancer in the elderly cannot be (avoided) because of the progressively aging population,'' Monfardini said.

Experts agreed that researchers must start including elderly patients in clinical trials, given that as the population in many countries continues to age, people over 70 will make up an increasing proportion of cancer patients.

People are considered elderly, in a medical context, once they are older than 65, but for cancer, patients are not considered elderly until they are 70.

One study presented at the meeting showed that elderly women with breast cancer can tolerate powerful medication.

Treatment for elderly breast cancer patients is usually influenced by the patient's age, instead of standard factors such as the size of the tumor, whether the cancer has spread to lymph nodes and how fast the tumor is growing.

Dr. Anne Chantal Braud examined the effects of surgery, radiotherapy, chemotherapy and hormone therapy in 179 women over 70 at the Institute Paoli Calmettes in Marseilles, France and found many elderly women who were fit did well with aggressive treatments.

In another study, Dr. Gilles Freyer of the South Lyon Central Hospital in Lyon, France, applied a geriatric evaluation test to 83 women over 70 suffering from advanced ovarian cancer.

He found that women who were depressed before treatment began, those who couldn't take care of themselves at home and those living in nursing homes were particularly vulnerable to the toxic side effects and that the chemotherapy was less effective in those women.

He also found that the women fared worse on cancer treatment if they were taking lots of medication for other illnesses.

``Chronological age has no influence on survival in our population,'' Freyer told doctors.

He concluded that a multidimensional geriatric evaluation test may help doctors predict how well individual elderly patients will tolerate side effects and benefit from chemotherapy for advanced ovarian cancer.

``Oncologists should weigh up the cumulative effects of these factors when making decisions about treatment,'' Freyer said. ``Standard therapy however, should be made available to patients as far as possible.''

Another study, involving 521 English Hodgkin's disease patients of all ages, found that age did not influence survival, but that the presence of other illnesses, particularly heart or breathing problems, were the main obstacles to elderly patients beating the cancer.