R E F E R AT

CHEMOTHERAPY IN
G E R I AT R I C P O P U L AT I O N
Siti Hani Amiralevi

G E R I AT R I C D E PA R T E M E N T
FA C U LT Y O F M E D I C I N E
TA N J U N G P U R A U N I V E R S I T Y P O N T I A N A K
R S U D A D E M D J O E N S I N TA N G
2018
 BACKGROUND
Poor tolerance to
Aging Patients often present
chemotherapy
with multiple comorbid
incidence of cancer
conditions and a
increases with age higher rate of
disability.
Cancer Chemotherapy

Associations between age and both

Undertreated for pharmacokinetics and
fear ofexcessive pharmacodynamics as well as
toxicity changes in aging organs

2
C A N C E R I N E L D E R LY

• Cancer in the elderly is quite diverse. Risk factors for cancer in a person
consist of internal and external factors, gene mutations, lifestyle, physical
activity, living environment until certain viral infections are risk factors that
are common in the community.
• Symptoms that arise are also very varied, generally elderly cancer or
cancer that occurs at an early age and adult cancer, causing nausea,
vomiting, dizziness, and some cancers arise lumps that are visible to the
eye and hide behind layers of skin and flesh.

3
Physiologic
Changes in
Older Adults

4
Age-related physiologic
changes affecting
pharmacokinetics

5
 ABSORPTION
• Changes in the function of the gastrointestinal
tract in old age include impaired acid secretion,
and decreased absorptive surface, splanchnic
blood flow and gastrointestinal motility.
DISTRIBUTION
 Depends largely on its relative aqueous
and lipid solubility, the degree of its binding to
plasma proteins and specific tissues, and the
total blood flow.
 A decrease in lean body mass and total body
water, and an increase in body fat, which are
well-documented body compositional
alterations in the elderly, affect the volume of
distribution and the elimination half-life of a
drug
6
 METABOLISM
• Liver size decreases by 18-44% between the
ages of 20 and 80 years, and hepatic blood flow
declines at a rate of 0.3-1.5% per year after the
age of 25.
• In consequence, first-pass metabolism of flow-
dependent drugs would be reduced, leading to
higher plasma concentrations and reduced
systemic clearance of the drugs.
EXCRETION
 Both renal structure and function deteriorate with
aging. Renal weight, renal blood flow, the number
of functioning glomeruli and the glomerular
filtration rate after the age of 30 years and
therefore the clearance of drugs which are
eliminated mainly from this organ is reduced.
 Cisplatin, measured for both ultrafilterable
platinum and total plasma platinum, is significantly
increased with age. The overall elimination half-life
of methotrexate is inversely related to creatinine
clearance and is prolonged in the elderly
7
 MUCOSITIS PULMONARY TOXICITY
• For all antineoplastic agents interfering with cell  The vital capacity and forced expiratory volume in
division, the oral mucosa is one of the target the first second decrease, and the residual volume
tissues most commonly affected. increases with age as a result of the diminished
• Mucositis is typically observed after the use of elastic force of the lung.
methotrexate, 5-fluorouracil, doxorubicin and  Among many anticancer drugs causing pulmonary
bleomycin. The severity of mucositis may be toxicity, only bleomycin is shown to be associated
affected by aging, because age-related depletion with increased toxicity in the elderly. Bleomycin
of mucosal stem cells leads to delayed renewal directly injures the pulmonary capillary
of epithelial cells in the mucosa. endothelium and type I pneumocytes, leading to
diffuse alveolar damage and interstitial fibrosis.

8
 TOXICITIES
• A major concern when treating older adults with
chemotherapeutic agents.
• Studies have suggested that older patients with
cancer are more susceptible to developing toxicities.
• Myelotoxicity, cardiotoxicity, mucosal toxicity, and
neurotoxicity appear to occur
more frequently in older patients receiving
chemotherapy.

9
TOXICITIES
MYELOSUPPRESSION
• Occurs more frequently and with greater severity,
resulting in higher risk of infection, altered tissue
perfusion, and bleeding.
• Severe anemia  dyspnea, headache, fatigue,
dizziness,decreased cognition, sleep
disturbances, altered sexual function, and
significant debilitation.
• Thrombocytopenia increases the risk of
bleeding  nonsteroidal anti-inflammatory drugs,
certainantibiotics, phenothiazines,
antidepressants, and, of course, aspirin products.
CARDIOTOXICITY
 Congestive heart failure (CHF) was a
significant sign of cardiotoxicity in older
patients receiving doxorubicin 
Tachycardia, shortness of breath, neck
vein distension, gallop rhythms, ankle
edema, hepatomegaly, cardiomegaly, and
pleural effusions.
 Additional symptoms of CHF in the
geriatric population may include anorexia,
restlessness, delirium, cyanosis, and falls
10
TOXICITIES
GI TOXICITY
• Clinical manifestations include mucositis,
taste alteration, nausea, vomiting,
constipation, and diarrhea.
• For instance, older patients may be more
susceptible to mucositis because of the
decreased reserves of replacement cells.
• Potential interventions for gastrointestinal
toxicities include administering antiemetics
before, during, or after chemotherapy to
prevent or treat nausea and vomiting
NEUROTOXICITY
 Some studies have reported that neurotoxicity
occurs with the same frequency in the
geriatric population as in younger patients.
 can result in cerebellar dysfunction and
peripheral neuropathies. loss of balance,
impaired communication, and impaired
muscle coordination creating gross disability
 Vincristine is an example of one drug
used in older patients with cancer that has
the potential to cause peripheral neuropathy
11
KARNOFSKY
PERFORMANCE
S TAT U S S C A L E
• Allows patients to be classified as to their
functional impairment.
• This can be used to compare effectiveness
of different therapies and to assess the
prognosis in individual patients.
• The lower the Karnofsky score, the worse
the survival for most serious illnesses.

12
CONCLUSSION

Gerontologic considerations in
the delivery of oncology health
care become more important
as the population ages and
older adults develop cancer
P h ys i o l o g i c a g e - r e l a t e d
changes, comorbidities,
and the incidence of Chemotherapy can be
p o l yp h a r m a c y i n o l d e r administered safely and
p a t i e n t s wi t h c a n c e r e ff e c t i v e l y i n o l d e r
make administration of p a t i e n t s wi t h c a n c e r
chemotherapy more wh e n a p p r o p r i a t e a g e -
challenging. related standards of care
are maintained.

13
 CONCLUSION
• Age-related physiologic changes, including alterations in the gastrointestinal system,
renal system, body composition, and hematopoiesis, impact patients’ ability to
tolerate standard doses of chemotherapy.
• Older patients with cancer may be more susceptible to developing toxicities from
chemotherapy, and these toxicities may be more severe.

14
THANK YOU
15