Geriatrische Onkologie - Zu alt für eine Chemotherapie?

Zusammenfassung

Tumoren betreffen in der Mehrzahl Menschen im höheren Lebensalter: Bei Diagnosestellung sind zirka zwei Drittel aller Patienten über 65 Jahre alt. In den kommenden Jahren wird aufgrund der demografischen Entwicklung in Deutschland der Anteil alter Menschen mit Tumorerkrankungen sogar noch größer werden. Somit wird auch die Betreuung geriatrisch-onkologischer Patienten für viele klinische Bereiche zu einer zunehmenden Herausforderung werden. Zudem existieren für viele Tumorentitäten aufgrund der deutlichen Unterrepräsentation älterer Patienten in klinischen Studien keine ausreichenden Evidenzen zum optimalen therapeutischen Vorgehen, was die Situation zusätzlich erschwert. Amerikanischen Daten zufolge waren nur etwa 30 % aller Patienten, die an onkologischen Therapiestudien teilnahmen, 65 Jahre oder älter, nur 1-3 % der Patienten war über 75 Jahre alt.

Summary

Tumors are diseases of the elderly: nearly two thirds of newly diagnosed tumors are found in individuals aged 65 years and older. Taking into account the demographic changes in the Western world, the number of geriatric patients with a tumour is expected to rise in the coming years. The management of older cancer patients will become a daily challenge for many medical specialities. The situation is complicated by the fact that due to the underrepresentation of older cancer patients in clinical trials, optimal treatment for this cohort is often ill-defined. Data from US study groups document that of all patients participating in clinical cancer trials, only 30 % were > 65 years old, and only 1-3 % were 75 years or older. A number of factors can have a negative impact on treatment tolerance in elderly patients, making a careful choice of cancer therapy and optimized supportive care mandatory. When deficits are identified, it is of great importance to distinguish between age-related physiologic changes in organ function and potentially reversible conditions caused by the tumor or comorbidities. In many cases, elderly cancer patients are not offered treatment using cytotoxic therapy on the grounds of physiologic, cognitive, emotional, or socio-economic limitations. Positive results from clinical trials, not only regarding response rates, but more importantly demonstrating impact on quality of life and symptom control in the therapy of elderly patients suffering from colorectal or lung cancer, underline the role chemotherapy can play in this cohort. Therefore, a thorough risk-benefit analysis should be performed before treatment decisions are taken. A critical evaluation of assessment criteria is equally important as the development and distribution of guidelines related to the management of elderly cancer patients.

Key Words

elderly - cancer - chemotherapy - treatment decision - comprehensive geriatric assessment

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Anschrift des Verfassers