Impact of Age and Comorbidities on the Treatment of Gastrointestinal Malignancies》.pdfVIP

Impact of Age and Comorbidities on the Treatment of Gastrointestinal Malignancies Jennifer Y. Wo, MD,* Theodore S. Hong, MD,* and Lisa A. Kachnic, MD*,† Gastrointestinal malignancies are generally considered diseases that affect older patients, with a peak in incidence in the sixth and seventh decades. Age has often been a surrogate to screen patients who may have more difficulty in tolerating treatment and the related side effects; however, chronologic age does not necessarily correlate with physiological organ impairment or poor performance status, both of which can vary substantially between individuals. Therefore, the assessment of candidacy for the ability to tolerate optimal cancer treatment should focus on the assessment of the extent of comorbidity and func- tional status. The review aims at providing a broad overview of the published literature regarding the tolerability and efficacy of standard treatment approaches for the most common gastrointestinal malignancies, including esophageal, pancreatic, and colorectal cancer, among elderly patients. Semin Radiat Oncol 22:311-320 © 2012 Elsevier Inc. All rights reserved. ith an aging baby boomer population and continued to enroll them onto clinical trials.6,7 This decision may ulti- Wincremental improvements in longevity, individuals mately affect overall patient outcome, with reduced cancer- aged 65 years in the United States are projected to comprise specific and overall mortality seen among those who receive approximately 20% of the total population by 2030.1 An cancer treatment.8,9 Chronologic age does not neces