Approaches to drug therapy in older cancer patients

Cancer in the elderly is an increasing social and medical problem. More than 50% of all cancers and cancer deaths occur in patients over age 65. The treating physician must not only carefully evaluate these patients relative to their neoplasm (careful history and physical exam, appropriate laboratory investigations), but also must assess any comorbid conditions that can impact upon drug toxicity or overall survival expectations. This article will discuss recommendations for chemotherapy in the elderly in regard to individual drugs as well as strategies for particular cancers. Although this will provide background information, it is still imperative to discuss therapy with the patient concerning his or her wishes and expectations before individual therapy is initiated. This is neither more nor less valid for the elderly patient than for any other patient with malignancy.