Minimising the side effects of cancer chemotherapy in senior patients

Over 50% of cancer deaths occur in persons aged over 65 years, but because of presumed increased toxicity of chemotherapeutic agents in the elderly, they are frequently treated with reduced doses. However, a review of the literature suggests that chronological age alone does not account for increased toxicity in the elderly. If changes in physiological function, the presence of other illness, and the use of concomitant drugs are taken into consideration, chemotherapy can be used safely and effectively in the elderly. However, this knowledge must be used with the understanding that while response rates are not lower in the elderly, the cancers most commonly encountered are notoriously unresponsive to chemotherapy. Thus, a strategy to use chemotherapy safely and effectively in the elderly involves careful selection of those cancers to be treated, full assessment of the patient's physiological functions, and a knowledge of the adverse effects of the individual agents used. Finally, the use of a limited treatment plan and an understanding of the principles of symptom relief can help optimise treatment throughout the course of the cancer.