Aging is associated with reduced functional reserve of multiple organ systems, increased prevalence of comorbidity, memory disorders, depression, malnutrition, polypharmacy and functional dependence 51. It is legitimate to ask whether these conditions may interfere with the treatment of cancer and may reduce the patient's life expectancy and tolerance of treatment to the point that treatment is futile or even harmful.
In three studies, cancer patients aged 70 and older had undergone a comprehensive geriatric assessment prior to the institution of treatment, with similar conclusions 52-54 Some form of functional dependence was present in up to 70% of patients, some form of comorbidity in up to 90%, depression, malnutrition and memory disorders in approximately 20% and polypharmacy in 40%. . A review of the Surveillance, Epidemiology and End Results (SEER) data also revealed that some form of comorbidity was present in the majority of cancer patients aged 65 and older 55. These studies show the benefits of a comprehensive evaluation of older individuals that allows an estimate of life expectancy and tolerance of treatment, recognition of conditions that should be reversed prior to treatment and the utilization of a common language in the definition of older individuals 56. As a result of these studies should be highlighted the need to adjust the doses of chemotherapy to the renal function of older individuals, to investigate anemia, that is a risk factor for mortality, functional dependence, and chemotherapy related toxicity, the management of depression, and the provision of a home caregiver in patients at risk to develop functional dependence during cancer treatment.
Another series of study compared the survival and the general function of older cancer patients with that of individuals of same age without cancer. Diab et al review the SEER breast cancer experience and showed that for women aged 75 and older breast cancer was not associated with a change in survival. Unexpectedly, breast cancer was associated with a more prolonged survival in women aged 80 and older. This observation suggests that breast cancer may affect preferentially women in best general condition,
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