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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Optimal differentiated thyroid cancer management in the elderly.

Donald S A McLeod1, Kelly Carruthers, Dev A S Kevat

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Summary

Differentiated thyroid cancer is rising globally. An explicit risk-benefit approach is crucial for older patients, balancing treatment success against potential adverse effects for optimal care.

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Area of Science:

  • Oncology
  • Endocrinology
  • Geriatric Medicine

Background:

  • Global incidence of differentiated thyroid cancer (DTC) is rising across all age groups.
  • While DTC often has a good prognosis, aggressive forms and mortality are higher in the elderly.
  • Standard treatments include surgery, levothyroxine, radioactive iodine, radiotherapy, and kinase inhibitors.

Purpose of the Study:

  • To advocate for a risk-benefit analytic approach in managing differentiated thyroid cancer, especially in older individuals.
  • To emphasize tailoring treatment based on individual patient factors, disease biology, and age-dependent treatment toxicities.
  • To guide the identification of aggressive disease and balance treatment efficacy with adverse effects.

Main Methods:

  • Review and synthesis of current evidence on differentiated thyroid cancer management.
  • Analysis of age-dependent treatment toxicities and disease progression factors.
  • Proposal of a risk-benefit framework for clinical decision-making.

Main Results:

  • Older patients with DTC face higher risks of aggressive disease and treatment toxicities.
  • A tailored, risk-benefit approach is essential for optimizing outcomes in elderly DTC patients.
  • Identifying aggressive disease is key to balancing treatment benefits and harms.

Conclusions:

  • An explicit risk-benefit analysis is vital for rational and evidence-based management of differentiated thyroid cancer in all patients, particularly the elderly.
  • This approach should integrate individual patient factors, disease characteristics, and age-specific treatment considerations.
  • Multidisciplinary collaboration is essential to balance treatment success likelihood with the probability of adverse effects.