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Older Patients Can Handle Chemotherapy

Study counters assumption that chemo hits elders too hard

From the WebMD Archives

Feb. 3, 2003 -- Chemotherapy is hard on anyone at any age, but many doctors have long thought it's more difficult for older people to endure. Not so, according to new research.

A new study published in the Feb. 15 issue of Cancer shows that people 70 and older actually handle chemotherapy pretty well. The study looked at 60 cancer patients undergoing chemotherapy, and examined changes in their functional, mental, nutritional, and quality of life measures. Even though the patients did experience overall decreases, the changes were surprisingly minor.

"It was quite encouraging to see that despite the fact that patients had toxicities from the chemotherapy, their overall functional status was not altered unduly. They were more tired ... but clinically they were doing pretty well. We had few people who were really crushed down (by the treatment)," researcher Martine Extermann, MD, PhD, an assistant professor of oncology and medicine at the University of South Florida, tells WebMD.

Overall, the people in the study were a good representative of the kinds of patients seen by oncologists, Extermann says.

Other studies have previously shown that healthy older adults do reasonably well on chemotherapy, but this study includes patients with a wider range of health conditions.

The results counter a reported perception among many doctors that older patients have less physical reserve than younger patients and will not stand up well to chemotherapy. The key factor, says Extermann, is that patients need to receive lots of supportive care, including steps such as monitoring levels of infection-fighting white blood cells and staving off dehydration. "The symptoms need to be treated early in order to maintain (a patient's well being)," she says.

Even patients who decide against chemotherapy would be well served by a visit to an oncologist, Extermann says. Primary care doctors do not deal with cancer on a regular basis and may not be aware of the supportive care options that are available, such as treatments for cancer pain. "It's worth it to get the advice of an oncologist about symptomatic treatment and supportive care, to get a good picture of all of the options available."

The kid gloves treatment of older patients is not just limited to cancer diagnoses, according to Barney Spivack, MD, who is director of geriatric medicine at Stamford Health System in Connecticut. "There is plenty of evidence that older people are not given access to what may be effective cardiac interventions that might be used in someone 20 years younger. It's part of that mindset that some physicians have that just because someone is older they many not benefit, or do as well, or even deserve some kinds of treatments," he tells WebMD.

During the course of the study, Extermann saw some evidence that attitudes can change. "In the beginning we really had to convince the community physicians that this (chemotherapy) was an option. As the physicians in the Tampa area have seen patients fare pretty well with treatment, we have seen patients of increasing age (being sent to) our clinic," she says.

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SOURCES: Martine Extermann, MD, PhD, assistant professor of oncology and medicine at the University of South Florida • Barney Spivack, MD, director of geriatric medicine at Stamford Health System, Stamford, Conn.
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