Bulletin du cancer
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Life expectancy increasing and cancer incidence rising with age, geriatric and cancer care will become a significant medical, public health, challenge. It is possible that the lack of efficacy of cancer therapies in the elderly may simply be due to the fact that physicians reduce anticancer drug doses empirically, in order to avoid "putative" toxicities that might arise as a result of alterations of physiological functions or as a result of co-morbidities generally present within this population. However, many authors have demonstrated that some patients over 70 years old could tolerate and obtain same benefit from therapies as younger adults, when some who are frail need less aggressive therapies. ⋯ Such studies have been successfully conducted in the elderly, some of them leading to dose recommendations. This paper detail the different sources of PK-PD variability in the elderly, some practical considerations regarding the design of studies using the population approach, as well as some examples of studies performed in the elderly. We conclude with some recommendations in this population at risk.
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The optimal management of elderly patients with cancer includes, besides the tumour assessment, a geriatric evaluation procedure. To date, comprehensive geriatric assessment (CGA) remains the gold standard of evaluation in older patients. ⋯ This approach has been developed to help oncologists differentiate the healthy elderly from other older patients whose problems would possibly interfere with cancer treatment and who require a pre-treatment CGA. Studies have shown that healthy older patients derive no advantage from CGA, but benefit from cancer treatment as much as younger patients.