Download Chemotherapy in the Elderly: Supportive Measures for

This material is protected by U.S. copyright law. Unauthorized reproduction is prohibited. To purchase quantity reprints,
please e-mail [email protected] or to request permission to reproduce multiple copies, please e-mail [email protected].
Downloaded on 05 13 2017. Single-user license only. Copyright 2017 by the Oncology Nursing Society. For permission to post online, reprint, adapt, or reuse, please email [email protected]
FEATURE ARTICLE
Chemotherapy in the Elderly:
Supportive Measures for
Chemotherapy-Induced Myelotoxicity
Linda Edwards Hood, RN, MSN, AOCN ®
he U.S. populace is agBiologic Changes
Not only is the U.S. populace aging, but the incidence of
ing, and elderly patients
Associated
(ages 65 and older) are
cancer in the elderly also is increasing. Many elderly pabecoming an increasingly larger
With Aging
tients with cancer can obtain the same benefits from stanproportion of the patient popudard chemotherapy as younger patients can, but the eldBiologic changes in elderly
lation. As the elderly population
people affect the likelihood of
erly are more susceptible to the myelotoxicity of chemoincreases, the incidence of candeveloping cancer. These chancer and the number of cancertherapy, which can limit the dose intensity of their treatges also can alter the activity of
related deaths in the elderly also
ments. Nurses can help identify patients at risk before they
tumors in patients with cancer as
are increasing (Lyman, Kuderer,
are treated with chemotherapy and discuss the need for
well as their responses to treat& Balducci, 1998; Yancik &
ments. In general, elderly paRies, 2000). The elderly curhematopoietic support with other members of the treattients are at greater risk of canrently constitute only 13% of the
ment team. They also can provide ongoing patient and
cer and are more susceptible to
population, but more than half
family education and teach patients to recognize and rethe toxic effects of chemoof all cancers and about twoport
early
symptoms
of
potential
problems.
Appropriate
therapy (Balducci, 2001).
thirds of all cancer-related
As people age, cumulative
deaths occur in this age group
supportive measures, such as granulocyte–colony-stimudamage occurs to their DNA. If
(Balducci, 2001; Yancik &
lating factor, reduce the risk of chemotherapy-induced
DNA damage involves specific
Ries) (see Figure 1).
neutropenia
and
related
infections
and
make
the
use
of
genes, such as oncogenes or tuThe higher incidence of canfull-dose chemotherapy possible in elderly patients despite
mor-suppressor genes, it can
cer in the elderly may be attriblead to the development of canuted to two factors: greater cutheir greater risk of myelosuppression.
cer (Balducci, 2001). In younger
mulative carcinogenic effects
Key
Words:
aged,
antineoplastic
protocols,
immunosuppeople, a number of mechanisms
over time and age-related mopression, granulocyte–colony-stimulating factor
protect the body from cellular
lecular changes (such as dedamage, including enzymes that
creased production of protective
deactivate reactive oxygen speenzymes and hormones) in various tissues (Dixon et al., 1986; Gómez et al., 1998;
cies,
hormones
that aid cellular repair, and
(Balducci, 2001; Balducci & Extermann, Vose et al., 1988). Aging is an individual2000a). Higher mortality rates in elderly pa- ized process, however, and several studies mitochondria-mediated apoptosis of cells
tients with cancer may be caused by other have shown that patients’ clinical outcomes that contain damaged DNA (Balducci). Agdisease states or related to their treatments are more likely to correlate with their physi- ing is associated with deficiencies in these
because of elderly patients’ potentially cal, mental, emotional, and functional sta- protective systems, allowing DNA-damaged
lower tolerance to therapy (Balducci; tus than with their chronologic age cells with malignant potential to persist and
eventually develop into cancer.
Yancik & Ries, 2000). Reductions in che- (Balducci; Balducci & Extermann, 2000a).
motherapy dose intensity, a common pracThis article discusses issues in cancer and
tice in the elderly patient population, also chemotherapy in elderly patients and the
Submitted September 2002. Accepted for
may contribute to death rates because re- need for treatment protocols and supportive
publication October 16, 2002.
duced dose intensity is associated with lower measures that are more appropriate for this
response rates and decreased survival patient population.
Digital Object Identifier: 10.1188/03.CJON.185-190
T
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 7, NUMBER 2 • CHEMOTHERAPY IN THE ELDERLY
185