Myelosuppression and its consequences in elderly patients with cancer

Cancer is a disease of the elderly, and its incidence and mortality increase with age. The number of persons with cancer is expected to double between 2000 and 2050, from 1.3 million to 2.6 million, with the elderly accounting for most of this increase. Studies have shown that otherwise-healthy older patients treated with chemotherapy of similar intensity obtain benefits comparable to those obtained by younger patients. However, chemotherapy-induced neutropenia and its complications are more likely in older patients; they are also more often hospitalized because of life-threatening infectious complications. Furthermore, most neutropenic episodes in elderly patients occur in the early cycles of chemotherapy. To minimize the occurrence of chemotherapy-induced neutropenia, older patients are often treated with less-aggressive chemotherapy and with dose reductions and delays, which may compromise treatment outcome. The proactive management of myelosuppression is therefore essential in elderly patients. Research to determine the predictors for neutropenia has found that age itself is a significant risk factor. The benefit of treating elderly patients with colony-stimulating factors is well established, with their use beginning in the first cycle of chemotherapy being crucial for minimizing neutropenia and its complications and facilitating the delivery of full-dose chemotherapy. Such prophylaxis should be routinely considered in elderly patients with cancer treated with myelosuppressive chemotherapy.