Management of Breast Cancer in Older Women (eBook)

Malcolm W. Reed, Riccardo A. Audisio (Herausgeber)

eBook Download: PDF

2010 | 2010
XVI, 413 Seiten
Springer London (Verlag)
978-1-84800-265-4 (ISBN)

Infos

I was looking at Mrs T - all 45 kilos of her - with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, 'because it was making her tired.' As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T's kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? 'Physicians,' said Voltaire, 'pour drugs they know little for diseases they know even less into patients they know no- ing about.' Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.

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I was looking at Mrs T - all 45 kilos of her - with somewhat puzzled thoughts. I had prescribed her capecitabine at very prudent doses, in view of her 91-year-old kidneys and physiology. She had reduced my treatment even further, "e;because it was making her tired."e; As a result, she was taking a grand total of 500 mg of capecitabine a day. Yet, her metastatic, ER/PR-negative, Her2-positive breast cancer was undoubtedly responding. Her pain was improving and her chest mass was shrinking, as were her lung metastases... What was the secret of that response? Were Mrs T's kidneys eli- nating even less drug than predicted by her creatinine clearance? Was her sarcopenia altering drug distribution? Was she absorbing more drug than average? Or was her tumor exquisitely sensitive to fluoropyrimidines? "e;Physicians,"e; said Voltaire, "e;pour drugs they know little for diseases they know even less into patients they know no- ing about."e; Medicine has made tremendous progress since the eighteenth century. Yet, there are fields where quite a lot remains to be learned. In developed countries, 25% of breast cancers occur in patients aged 75 years and older. Yet, these patients represent only 4% of the population of traditional clinical trials. That ought to let us wonder how relevant data acquired in patients in their 60s are to a nonagenarian. Fortunately, geriatric oncologists have been stepping up to the task and have gen- ated data to help us to treat such patients.

Inhalt

Foreword 5
Preface 6
Contents 8
Contributors 11
Background and Epidemiology 15
Basic Science of Breast Cancer in Older Patients 16
Tumor Biology and Pathology 33
Clinical Epidemiology and the Impact of Co- Morbidity on Survival 48
Special Considerations in the Managemant of Older Women 62
Comprehensive Geriatric Assessment 63
A Practical Mini-Guide to Comprehensive Geriatric Assessment 74
Impact of the Physiological Effects of Aging on the Pharmacokinetics and Pharmacodynamics of Systemic Breast Cancer Treatment 84
Impact of Hormone Replacement Therapy on Breast Cancer 109
Experiences of a Multidisciplinary Elderly Breast Cancer Clinic: Using the Right Specialists, in the Same Place, with Time 117
Therapeutics 132
Mammographic Breast Screening in Elderly Women 133
Primary Endocrine Therapy for the Treatment of Early Breast Cancer in Older Women 149
Peroperative Radiotherapy 171
General and Local Anesthetics 188
The Surgical Management of Breast Cancer in Elderly Women 201
Breast Reconstruction 216
Adjuvant Endocrine Therapy 233
Adjuvant Chemotherapy 250
Adjuvant Radiotherapy 264
Prevention and Treatment of Skeletal Complications 276
Medical Management of Advanced Disease 299
The Use of Chemotherapy in Elderly Cancer Patients: Dose Adjusting, Drug Interactions, and Polypharmacy 314
Psychosocial Considerations 330
Delayed Presentation of Breast Cancer in Older Women 331
Patient Decision Making 340
Culture, Ethnicity, and Race: Persistent Disparities in Older Women with Breast Cancer 346
Supportive, Palliative and End-of-Life Care for Older Breast Cancer Patients 367
Index 400

Produkt-Details

• Erscheint lt. Verlag: 18.1.2010
• Zusatzinfo: XVI, 413 p.
• Verlagsort: London
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Geriatrie
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie
• Themenwelt: Studium ► 2. Studienabschnitt (Klinik) ► Anamnese / Körperliche Untersuchung
• Schlagworte: aging • Assessment • Cancer • diagnostic radiology • Geriatrics • surgical oncology • Tumor
• ISBN-10: 1-84800-265-3 / 1848002653
• ISBN-13: 978-1-84800-265-4 / 9781848002654