McKenna R J
Wilshire Oncology Medical Group, San Gabriel, CA 91776.
Cancer. 1994 Oct 1;74(7 Suppl):2107-17. doi: 10.1002/1097-0142(19941001)74:7+<2107::aid-cncr2820741719>3.0.co;2-1.
Fifty-five percent of human cancer occurs in individuals 65 years of age and older; the most common sites are the stomach, colon, rectum, prostate, and breast. Patient delay in seeking care for symptoms may result in diagnosis at a more advanced stage than that seen in younger individuals. Treatment decisions may be impacted by comorbid illness and by physician reluctance to treat the elderly patient as they do the younger. Age alone never should be the factor that modifies a cancer treatment plan. Clinical trials rarely are available to the elderly; it is time that such treatment bias ceased. Adequate informed consent is as important in the elderly as it is in other age groups. Quality of life after cancer treatment is most important to the elderly cancer patient. Surgery and/or radiotherapy may be used for cancer treatment in the elderly when comorbid conditions are treated appropriately. Chemotherapy schedules may need modification when renal or hepatic function is impaired. Compliance with treatment is usually good if transportation is available. Pain management is important in this age group and requires individualization. Home health care is of great benefit to the elderly patient with cancer. Oncologic nursing for the elderly requires multiple skills. The literature on cancer treatment for the elderly is limited and, at times, negative. Cancer treatment in the elderly is remarkably safe when the comorbid conditions also are treated. Treatment choices are just as important to the elderly as they are to all cancer patients. Quality-of-life issues are critical in selecting treatment choices. Cancer follow-up is performed most appropriately by the oncologist.
55%的人类癌症发生在65岁及以上的人群中；最常见的发病部位是胃、结肠、直肠、前列腺和乳腺。患者出现症状后延迟就医可能导致确诊时病情比年轻患者更为严重。治疗决策可能会受到合并症以及医生不愿像对待年轻患者那样治疗老年患者的影响。年龄本身绝不应成为改变癌症治疗方案的因素。针对老年人的临床试验很少；这种治疗偏见早该停止了。充分的知情同意对于老年人和其他年龄组一样重要。癌症治疗后的生活质量对老年癌症患者最为重要。当合并症得到适当治疗时，手术和/或放疗可用于老年癌症患者的治疗。当肾功能或肝功能受损时，化疗方案可能需要调整。如果有交通便利条件，患者通常对治疗的依从性良好。疼痛管理在这个年龄组很重要，需要个体化。居家医疗保健对老年癌症患者大有裨益。老年肿瘤护理需要多种技能。关于老年癌症治疗的文献有限，而且有时是负面的。当合并症也得到治疗时，老年癌症治疗相当安全。治疗选择对老年人和所有癌症患者一样重要。生活质量问题在选择治疗方案时至关重要。癌症随访由肿瘤学家进行最为合适。
