Symptom management in the elderly cancer patient: fatigue, pain, and depression

Patients who are > or =65 years of age are the fastest growing segment of the U.S. population. These patients with already existing physiologic decline and comorbidities, when diagnosed with cancer, provide considerable challenges in management issues. Along with therapy for the tumor the practicing oncologist must also keep in mind the various symptoms, like fatigue, pain, and depression, that may occur due to the tumor itself or due to therapy. The prevalence of fatigue is greater than 50-70% in advanced cancer. The tools to measure fatigue are all subjective in nature and no one tool has been tested in the elderly cancer patient. Treatment of fatigue in the elderly may involve education, antidepressants, treatment of anemia, exercise, and use of psychostimulants. Pain is present is 80% of elderly patients with advanced cancer. Pain should be assessed in a systematic way and it has been shown that the Visual Descriptor Scale is the tool most preferred by the elderly. Several guidelines for management of pain exist and options include acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, adjuvant analgesics, and education of patients and caregivers. Depression is also a prevalent symptom arising from a variety of causes. There are many validated tools to measure depression in the elderly like the Geriatric Depression Scale. Treatment includes use of education, selective serotonin reuptake inhibitors, psychotherapy, and electroconvulsive therapy. There exists an interplay of many of these symptoms and quite often they can occur simultaneously in the elderly cancer patient. Future research is needed to expand our base of knowledge on the occurrence and management of each of these symptoms and to better understand how aging systems interact with these phenomena to produce unique situations in older adults.