Contemporary management of pancreas cancer in older people.

Abstract

As the population of western countries is aging, the number of patients diagnosed with cancer is growing. Therefore older people, more susceptible to develop pancreatic malignancy, will likely represent the prototype of a pancreatic cancer patient in the near future. Diagnostic modalities utilised for younger patients are also applicable for older individuals. There is accumulative evidence that biological age is not an independent factor predicting poor outcome in elderly patients with resectable disease undergoing surgery, however increased postoperative morbidity and mortality within the elderly group has also been reported. Adjuvant chemotherapy should be offered in all patients with good performance status regardless of their age. Palliative measures for unresectable tumours including relief from biliary and duodenal obstruction as well as chemotherapy should be considered in non-frail patients with reasonable life expectancy. Palliative chemotherapy options are FOLFIRINOX or gemcitabine/nab-paclitaxel for patients with good performance status (0-1) and gemcitabine alone for patients with performance status 2-3. The cornerstone for improving the outcomes of the elderly age group is careful patient selection and perioperative optimization of those who have indication for surgery. Patients and their carers should be involved in the decision making process with emphasis on the expected functional recovery after the proposed treatment modality. The presence of geriatricians in the multidisciplinary team meetings is crucial in order to identify the optimal treatment pathway for elderly patients. Geriatric input regarding peri-habilitation pathways to improve surgical outcomes, to decrease mortality and to expedite patients' functional recovery is highly recommended.

• Authors: Minas Baltatzis, Maria Grazia Rodriquenz, Ajith K Siriwardena, Nicola De Liguori Carino
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 47 Issue 3 Pt A Pg. 560-568 (03 2021) ISSN: 1532-2157 [Electronic] England
• PMID: 32950314 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Chemical References

• folfirinox
• Oxaliplatin
• Deoxycytidine
• Irinotecan
• Paclitaxel
• Leucovorin
• Fluorouracil
• Gemcitabine

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Deoxycytidine (analogs & derivatives, therapeutic use)
• Enhanced Recovery After Surgery
• Fluorouracil (therapeutic use)
• Geriatric Assessment
• Humans
• Irinotecan (therapeutic use)
• Leucovorin (therapeutic use)
• Oxaliplatin (therapeutic use)
• Paclitaxel (therapeutic use)
• Pancreatectomy
• Pancreatic Neoplasms (diagnosis, therapy)
• Pancreaticoduodenectomy
• Gemcitabine