Most elderly women with advanced ovarian cancer are not given optimal treatment for fear of an adverse reaction, although there is little evidence to show that they are at greater risk than younger patients, say oncologists in France. The results of an investigation involving 83 women over the age of 70 were announced today (20 October 2002) and will help oncologists identify which patients are most like to benefit from standard chemotherapy.
Speaking at the European Society for Medical Oncology Congress in Nice, France, Dr Gilles Freyer from Centre Hospitalier Lyon Sud, France, said, "We simply do not know if elderly patients can tolerate these powerful drugs, because clinical trials often exclude patients over the age of 70 years, so the results that emerge are not fully representative of the age range of patients we have to treat."
There are a number of factors that have to be taken into account when planning a treatment strategy for older people. They may be more vulnerable to the toxic side effects of the therapy. They experience more psychological problems, such as depression, and it can be difficult for an oncologist to communicate effectively with an elderly person if their cognition is impaired. Transport to and from hospital is one of the practical difficulties for older people.
Patients who are depressed before treatment begins, patients who lack autonomy and those living in institution are at risk of toxicity and the treatment may be less effective. "Perhaps this is because they are more fragile and need more care than elderly women who lead independent lives," Dr Freyer suggested. Medication being taken at the same time for other illnesses is also a poor prognostic factor. These factors have an accumulative effect and oncologists should weigh these up when making decisions about treatment. Standard therapy should, however, be made available to patients as far as possible. Dr Freyer's study will help oncologists to evaluate the risks and benefits, and to predict the overall survival in elderly patients with advanced ovarian cancer.