This early Sunday morning education session presented information on how to manage ovarian cancer in the older women. Many women including myself do get diagnosed at an early age but the median age for diagnosis of ovarian cancer in women is 63 years of age.
Ovarian
Cancer Surgery in the Older Woman : Keep It Short and Sweet
Dr Linda Duska
Chronologic age is not the same as
physiologic age and age does not define the ability of a woman to undergo
surgery or medical treatment. Retrospective studies have showed that women with
ovarian cancer who have no gross residual disease after surgery have better
outcomes. Older women overall have a worse prognosis stage for stage than
younger women. The GOG182 study found that there was a lower chemo completion
rate among older women and that toxicity was higher. It has also been found
that for women of age 65 and older surgery complications increase and there is
higher mortality. It was recommended that an assessment tool like ones for
frailty be used before considering surgery in women over 65. It was found that
frail women were more likely to be obese and to have post-op complications.
Ovarian Cancer in the Older Women :
Less is More
Dr Kathleen Moore
Studies that focus on the older woman
are limited. SEER Medicare data shows that the use of chemotherapy in women decreases
as age increases. Women > age 70 have higher hematologic toxicity and stop
treatment early. A study done in France showed that while in pre-treatment and during
treatment the geriatric assessment showed that depression was a poor prognostic
factor. A US study, GOG 273 (women age 70 +) showed that dose modifications , timing
changes and variations on chemo schedule may help the older woman complete
chemotherapy.
The EWOC ( Elderly Women with OC)
studies showed that chemo toxicity could be predicted by 3 factors –
depression, dependence and performance status.
The MITO-5 and MITO -6 studies found that weekly carbo taxol was
associated with lower toxicity and higher quality-of-life scores.
Clinical Trials in the Older Patient:
Who,When and Why?
Dr William Tew
There are not many clinical trials for
older patients.
Dr Tew stated that it is important to
define who your patient is and what they want. He also recommended assessing
functional age not chronologic age. The Cancer and Aging Research Group has
developed and assessment tool that can be used before starting chemotherapy.
The assessment tool looks at factors that can predict grade 3-5 toxicities in
older patients. Some of the tool variables are age, impaired hearing, inability
to walk a block, decreased social activity etc.
From this session I learned that:
- better outcomes occur when older women finish chemotherapy- even if that means the dosage/timing needs to need modified.
- Depression and poor functional ability can impact treatment success
- Age itself does not predict whether or not a woman can undergo surgery or treatment .
- Assessment tools ( fraility / performance status) should be used before surgery
Tomorrow’s post will be on Value Concepts in the Management
of Ovarian Cancer
Dee
Every Day is a Blessing!
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