Kimmick G G, Fleming R, Muss H B, Balducci L
Comprehensive Cancer Center, Wake Forest University, Winston-Salem, North Carolina, USA.
Drugs Aging. 1997 Jan;10(1):34-49. doi: 10.2165/00002512-199710010-00004.
The incidence of cancer increases with age. Since the geriatric population is growing, we will be confronted with an increasing number of patients with cancer who are > 65 years of age. The purpose of this review is to address the use of cancer chemotherapy in older persons with respect to its tolerability. We performed a review of the literature using 'Medline' and the bibliographies of pertinent publications. Information about cancer treatment in older adults was extracted with particular attention to chemotherapy-related toxicity in patients aged > 65 years. Comorbid disease, polypharmacy/drug interactions, psychosocial issues and age-related physiological changes are major issues in caring for older patients with cancer. Since older individuals may have a greater number of comorbid illnesses, treatment should be initiated on the basis of physiological rather than chronological age. Comparative studies show that chemotherapy-related toxicity is similar in older and younger patients, with the exception of haematological toxicity, which may be more severe in older patients, and cardiotoxicity, which is more frequent in the elderly. Other evidence suggests that gastrointestinal and neurotoxicities may also be more severe in older individuals. The dosages of chemotherapeutic agents that are primarily renally excreted may require adjustment in older patients. Haematological reserve is decrease in older individuals, and drugs that cause myelosuppression must be used with care. The use of haemopoietic growth factors in geriatric patients is currently being investigated.
癌症发病率随年龄增长而上升。由于老年人口不断增加，我们将面临越来越多65岁以上的癌症患者。本综述的目的是探讨老年患者使用癌症化疗时的耐受性问题。我们利用“医学索引数据库（Medline）”及相关出版物的参考文献对文献进行了综述。提取了有关老年成年人癌症治疗的信息，尤其关注65岁以上患者与化疗相关的毒性反应。共病、多种药物联用/药物相互作用、心理社会问题以及与年龄相关的生理变化是老年癌症患者护理中的主要问题。由于老年人可能患有更多的共病，治疗应基于生理年龄而非实际年龄来启动。比较研究表明，除血液学毒性（老年患者可能更严重）和心脏毒性（在老年人中更常见）外，老年患者与年轻患者的化疗相关毒性相似。其他证据表明，胃肠道和神经毒性在老年人中可能也更严重。主要经肾脏排泄的化疗药物剂量在老年患者中可能需要调整。老年人的血液储备减少，必须谨慎使用引起骨髓抑制的药物。目前正在研究老年患者使用造血生长因子的情况。
