Review Article

Risk Analysis in the Treatment 
of Hematologic Malignancies in the Elderly

Sandra Kurtin, RN, MS, AOCN®, ANP-C

From the University of Arizona and Arizona Cancer Center, Tucson, AZ.

The author has no conflicts of interest to disclose.

Correspondence to: Sandra Kurtin, RN, MS, AOCN, ANP-C, Arizona Cancer Center, 3838 N. Campbell Ave, Tucson, AZ 85719. E-mail: skurtin@umcaz.edu


J Adv Pract Oncol 2010;1:19–29 | DOI: 10.6004/jadpro.2010.1.1.3 | © 2010 Harborside Press


  

ABSTRACT

Chronic lymphocytic leukemia (CLL), non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), acute myelogenous leukemia (AML), and myelodysplastic syndromes (MDS) represent the most common hematologic diseases in adults, with the majority of diagnoses in patients over the age of 65. Older adults (> 65 years) are expected to exceed 20% of the overall U.S. population by the year 2030. Given the predicted increase in the size of the older adult population along with the incidence of these cancers, health care providers must familiarize themselves with the needs of older adults with hematologic malignancies. Risk-adapted treatment approaches include primarily disease-specific prognostication. The effect of comorbidities and functional status on treatment outcomes has been evaluated in recent clinical trials. Functional decline is associated with loss of independence and decreased quality of life. Most of these hematologic diseases are not curable; therefore, the preservation of quality of life and independent function should remain a priority. Careful consideration of the patient and disease-related factors together with the expectations of the patient and the consistent availability of caregivers is necessary to provide the best outcome. Familiarity with recent clinical trials data, risk-adapted treatment guidelines, and the complex attributes of the older adult will provide the advanced practitioner sound clinical management strategies and effectively eliminate chronologic age alone as a barrier to treatment of common hematologic malignancies.


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