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I was looking at Mrs T – all 45 kilos of her – with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, “because it was making her tired.” As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T’s kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? “Physicians,” said Voltaire, “pour drugs they know little for diseases they know even less into patients they know no- ing about.” Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.
Little is known about what constitutes appropriate care for older women with breast cancer. Extending work begun as part of an National Cancer Institute-funded project, we are examining whether variations in care received by older women affect short-term psychosocial and clinical outcomes. Our specific aims are: (1) To describe patterns of adjuvant hormonal and chemotherapy in older women, and factors associated with receipt of these therapies; (2) To characterize and quantity the breast cancer-related care received by older women during the early years following diagnosis; and (3) To determiine the effects of ongoing breast cancer care on patients' quality of life. We are conducting a longitudinal observational study of a cohort of 350 women> 55 years of age diagnosed with stage I and II breast cancer between October 1992 and December 1995 at five sites in Boston, Massachusetts. Women are interviewed annually to obtain information about health and personal characteristics. Medical record abstracts are performed annually to gather information about treatments received, tests performed, and disease recurrences. Descriptive and multivariate analytic techniques will be used to identify patient and provider characteristics associated with variations in care received and the effects of these variations on patients' quality of life.
The purpose of this report is to present information on how the age structure of the overall population and the composition of the older population in terms of age, sex, race, and Hispanic origin are expected to change over the next four decades. Between 2010 and 2050, the United States is projected to experience rapid growth in its older population. In 2050, the number of Americans aged 65 and older is projected to be 88.5 million, more than double its projected population of 40.2 million in 2010. The baby boomers are largely responsible for this increase in the older population, as they will begin crossing into this category in 2011. The aging of the population will have wide-ranging implications for the country. As the United States ages over the next several decades, its older population will become more racially and ethnically diverse. Projecting the size and structure, in terms of age, sex, race, and Hispanic origin, of the older population is important to public and private interests, both socially and economically. The projected growth of the older population in the United States will present challenges to policy makers and programs, such as Social Security and Medicare. It will also affect families, businesses, and health care providers.
Breast cancer is a disease requiring multidisciplinary management including surgery, medical and radiation oncology, radiology, pathology, nuclear medicine, genetic counseling, and psychological support. Each member of the team needs to be updated continuously on breast cancer treatment because of its rapidly changing nature. From the diagnostic procedures to operations and even in metastatic stages of breast cancer, surgeons play an essential part in multidisciplinary teams. After standard surgical options, oncoplastic breast surgery is rapidly becoming one of the most important surgical topics that should be learned by attending surgeons. The idea of writing this book stemmed from a collaboration between the European Academy of Senology (EAoS), European Institute of Oncology (IEO), Euro-Asian Society of Mastology (ESOMA), and SENATURK (Turkish Academy of Senology), which have been working together to promote better training in breast care for professionals. The book offers invaluable support for breast surgeons by covering critical and essential information in senology. It will also greatly benefit the other members of multidisciplinary teams, surgery residents, gynecologists, and plastic and reconstructive surgeons.
This book presents comprehensive assessment and up-to-date discussion of the epidemiology, prevention, and treatment of cancer in the elderly, highlighting the growing demands of the disease, its biology, individual susceptibility, the impact of state-of-the-art and emerging therapies on reducing morbidity, and decision making processes. Describ
"In the preface to this impressive and well-produced book, the editors state that their aim is not to describe a new surgical specialty, since most surgeons will soon need to be "geriatric surgeons," but to assemble a comprehensive account that will allow "all providers of healthcare to the elderly to understand the issues involved in choosing surgery as a treatment option for their patients." This is a useful book that deserves to do well. I hope that the editors and their publisher will have the stamina to make this the first of several editions, as it is clear that updated information about surgery in the elderly will be required to keep pace with this important field." NEJM Book Review
This book offers evidence-based clinical knowledge of older patients suffering from breast cancer. It details the full armament of therapeutic options as well as the epidemiology of the disease and specific psychosocial considerations for elderly patients.
Cancer is clearly an age-related disease. Recent research in both aging and cancer has demonstrated the complex interaction between the two phenomena. This affects a wide spectrum of research and practice, anywhere from basic research to health care organization. Core examples of these close associations are addressed in this book. Starting with basic research, the first chapters cover cancer development, mTOR inhibition, senescent cells altering the tumor microenvironment, and immune senescence affecting cancer vaccine response. Taking into account the multidisciplinarity of geriatric oncology, several chapters focus on geriatric and oncologic aspects in patient assessment, treatment options, nursing and exercise programs. The book is rounded off by a discussion on the impact of the metabolic syndrome illustrating the interactions between comorbidity and cancer and a chapter on frailty.This book provides the reader with insights that will hopefully foster his or her reflection in their own research and practice to further the development of this most exciting field. Given the aging of the population worldwide and the high prevalence of cancer, it is essential reading not only for oncologists and geriatricians but for all health practitioners.