Life expectancy, comorbidity and quality of life: the treatment equation in the older cancer patients.

With ageing, function preservation and maintenance of quality of life represent a major goal in an increasing proportion of patients. Life expectancy is a function of age, comorbidity, disability and cancer type and stage. Decision-making involves a delicate balance among all these factors, evaluation of treatment related complications of the overall effects of cancer and cancer treatment on the patients' quality of life. Despite several instruments for the assessment of quality of life being validated, none have been calibrated to the special requirements of the older patients. The structured interview administered by a trained clinician represents a standard approach for geriatric research and even for clinical practice because of the frailty of the older population. The combination of this approach with the self-administered questionnaire appears the most effective way to minimise missing data in collecting information for patients unable to complete the form.

[1]  A. Dobson,et al.  Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. , 1981, Journal of chronic diseases.

[2]  R. Havlik,et al.  Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients , 1998, Cancer.

[3]  G. Lyman,et al.  Optimal duration of adjuvant tamoxifen treatment in elderly breast cancer patients: Influence of age, comorbidities, and various effectiveness hypotheses on life-expectancy and cost , 1996 .

[4]  Cella Df,et al.  Quality of life during and after cancer treatment. , 1988 .

[5]  P. Ganz,et al.  Predicting Psychosocial Risk in Patients With Breast Cancer , 1993, Medical care.

[6]  K. Hunt,et al.  Neoadjuvant chemotherapy, locally advanced breast cancer, and quality of life. , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  J. Blaustein,et al.  Comprehensive Geriatric Assessment in a Day Hospital , 1994, Journal of the American Geriatrics Society.

[8]  D. Karnofsky.  The clinical evaluation of chemotherapeutic agents in cancer , 1949 .

[9]  L. Ferrucci,et al.  Validation of a multidimensional evaluation scale for use in elderly cancer patients , 1996, Cancer.

[10]  I. Fentiman,et al.  Current Controversies in Cancer Should Adjuvant Chemotherapy be used to Treat Breast Cancer in Elderly Patients (2 70 years of age) , 1997 .

[11]  D. Karnofsky,et al.  The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma , 1948 .

[12]  G. Lyman,et al.  Comprehensive Geriatric Oncology , 1997 .

[13]  D. Fairclough,et al.  Comparison of Time-tradeoff Utilities and Rating Scale Values of Cancer Patients and Their Relatives , 1995, Medical decision making : an international journal of the Society for Medical Decision Making.

[14]  W. Satariano,et al.  The Effect of Comorbidity on 3-Year Survival of Women with Primary Breast Cancer , 1994, Annals of Internal Medicine.

[15]  D. Serraino,et al.  The impact of cancer on the physical function of the elderly and their utilization of health care , 1998, Cancer.

[16]  D. Reuben.  Geriatric assessment in oncology , 1997, Cancer.

[17]  R. Yancik.  Cancer burden in the aged , 1997, Cancer.

[18]  J. Guralnik,et al.  Assessing the impact of comorbidity in the older population. , 1996, Annals of epidemiology.

[19]  Colin M. MacLeod,et al.  Evaluation of chemotherapeutic agents , 1949 .

[20]  M. Tattersall,et al.  Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. , 1987, The New England journal of medicine.

[21]  B. Vellas,et al.  Life expectancy, comorbidity, and quality of life. A framework of reference for medical decisions. , 1997, Clinics in geriatric medicine.

[22]  W. Gianni,et al.  Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[23]  R. Figlin,et al.  Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky performance status and the functional living index—cancer , 1988, Cancer.

[24]  D. Haes.  Quality of Life: Conceptual and theoretical considerations , 1988 .

[25]  R. Yancik,et al.  Caring for elderly cancer patients. Quality assurance considerations , 1989, Cancer.

[26]  J Concato,et al.  Importance of functional measures in predicting mortality among older hospitalized patients. , 1998, JAMA.

[27]  P. Ganz,et al.  Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. , 1992, Journal of clinical epidemiology.

[28]  I. Fentiman,et al.  Should adjuvant chemotherapy be used to treat breast cancer in elderly patients (> or = 70 years of age)? , 1997, European journal of cancer.