Onkologische Erkrankungen im Alter

Mehr als die Hälfte der Menschen mit einer neu diagnostizierten onkologischen Erkrankung ist über 70 Jahre alt. In dieser Altersgruppe ist die Tumorbehandlung mit anderen Herausforderungen verbunden als bei Betroffenen im jüngeren Lebensalter. Dieser Beitrag fasst dazu den gegenwärtigen Erkenntnisstand zusammen und beschreibt die Besonderheiten von Diagnostik und Therapie onkologischer Erkrankungen im Alter.

Abstract

A majority of patients with newly diagnosed malignant disease are 70 years old or older. Frailty – i. e. increased vulnerability towards stressors at older age – is a major challenge during the oncological work-up and treatment in the elderly. Therefore, older cancer patients should receive a systematic assessment of frailty by use of standard tools. Assessment results should be carefully considered during oncological treatment decisions, e. g. in interdisciplinary tumor conferences. Moreover, they are prerequisite to initiate geriatric co-management for which there is emerging new evidence. Advances in tumor surgery and irradiation as well as personalized precision medicine with novel targeted drugs have facilitated the treatment of cancer even in old age and frailty. However, patients with such characteristics are at increased risk of complications compared to younger subjects. Physicians and medical staff involved in treatment must therefore co-operate well. This article provides an overview of the current evidence and highlights key aspects of diagnosis and treatment of malignant diseases in the elderly.

Schlüsselwörter

Frailty - geriatrisches Assessment - Chemotherapie - Präzisionsmedizin

Key words

frailty - geriatric assessment - chemotherapy - precision medicine

Publication History

Article published online:
26 August 2021

• Literatur

• 1 Robert-Koch-Institut, Zentrum für Krebsregisterdaten. Bericht zum Krebsgeschehen in Deutschland 2016. http://www.krebsdaten.de/Krebs/DE/Content/Publikationen/ ; Stand: 19.05.2021
• 2 Aunan JR, Cho WC, Soreide K. The Biology of Aging and Cancer: A Brief Overview of Shared and Divergent Molecular Hallmarks. Aging Dis 2017; 8: 628-642 DOI: 10.14336/AD.2017.0103.
• 3 Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci 2014; 69 (Suppl. 01) S4-S9 DOI: 10.1093/gerona/glu057.
• 4 Hurria A, Dale W, Mooney M. et al. Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 2014; 32: 2587-2594 DOI: 10.1200/JCO.2013.55.0418.
• 5 Hamaker ME, Stauder R, van Munster BC. Exclusion of older patients from ongoing clinical trials for hematological malignancies: an evaluation of the National Institutes of Health Clinical Trial Registry. Oncologist 2014; 19: 1069-1075 DOI: 10.1634/theoncologist.2014-0093.
• 6 Clegg A, Young J, Iliffe S. et al. Frailty in elderly people. Lancet 2013; 381: 752-762 DOI: 10.1016/S0140-6736(12)62167-9.
• 7 Jolly TA, Deal AM, Nyrop KA. et al. Geriatric assessment-identified deficits in older cancer patients with normal performance status. Oncologist 2015; 20: 379-385 DOI: 10.1634/theoncologist.2014-0247.
• 8 Bellera CA, Rainfray M, Mathoulin-Pelissier S. et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 2012; 23: 2166-2172 DOI: 10.1093/annonc/mdr587.
• 9 Wildiers H, Heeren P, Puts M. et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014; 32: 2595-2603 DOI: 10.1200/JCO.2013.54.8347.
• 10 Hamaker ME, Te Molder M, Thielen N. et al. The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients – A systematic review. J Geriatr Oncol 2018; 9: 430-440 DOI: 10.1016/j.jgo.2018.03.014.
• 11 Rockwood K, Song X, MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495 DOI: 10.1503/cmaj.050051.
• 12 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383 DOI: 10.1016/0021-9681(87)90171-8.
• 13 Hurria A, Togawa K, Mohile SG. et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 2011; 29: 3457-3465 DOI: 10.1200/JCO.2011.34.7625.
• 14 Extermann M, Boler I, Reich RR. et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer 2012; 118: 3377-3386 DOI: 10.1002/cncr.26646.
• 15 Puts M, Soo WK, Szumacher E. et al. Methods for frailty screening and geriatric assessment in older adults with cancer. Curr Opin Support Palliat Care 2021; 15: 16-22 DOI: 10.1097/SPC.0000000000000533.
• 16 Lavoue V, Gotlieb W. Benefits of Minimal Access Surgery in Elderly Patients with Pelvic Cancer. Cancers (Basel) 2016; 8 DOI: 10.3390/cancers8010012.
• 17 Daniels SL, Lee MJ, George J. et al. Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open 2020; DOI: 10.1002/bjs5.50347.
• 18 Desideri I, Salvestrini V, Livi L. Recent advances in de-intensification of radiotherapy in elderly cancer patients. F1000Res 2020; 9 DOI: 10.12688/f1000research.21151.1.
• 19 Hall PS, Lord SR, Collinson M. et al. A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO). Br J Cancer 2017; 116: 472-478 DOI: 10.1038/bjc.2016.442.
• 20 Wildiers H, de Glas NA. Anticancer drugs are not well tolerated in all older patients with cancer. The Lancet Healthy Longevity 2020; 1: e43-e47 DOI: 10.1016/S2666-7568(20)30001-5.