Cancer in older adults: understanding cause and effects of chemotherapy-related toxicities.

In an aging population, the risk of cancer in older adults aged 60 years or older is expected to rise significantly over the next decade. Older adults are more likely to develop and die from various hematological and solid cancers. Cancer-related complications, chemoresistance resulting in refractory cancer and cancer relapses certainly contribute to high mortality in older adults. For example, older adults with acute myeloid leukemia (AML) have a greater likelihood of high-risk karyotype and mutations resulting in a significantly lower probability of achieving remission [1,2]. Appropriately, the field of cancer research has maintained a focus on understanding cancer biology to enhance drug development, which has resulted in an unprecedented approval of new drugs for cancer in the last few years. In the last 2 years, eight new drugs have received approval from the US FDA for management of AML [1]. Supportive care such as use of antimicrobial agents, transfusion and growth factors have made chemotherapy safer for patients in general. However, in older adults, chemotherapy intolerance and toxicities play a larger role in poor survival and quality of life than what may have been appreciated by the oncology community in the past. For this reason, in recent years, patient-reported outcomes, geriatric assessment and symptom science have been increasingly incorporated in cancer care and research.