Management of pancreatic cancer in the elderly

• Published in: World journal of gastroenterology : WJG Vol. 22; no. 2; pp. 764 - 775
• Main Author: Higuera, Oliver
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.01.2016
• Subjects: adenocarcinoma; Age Factors; Aged; Aged, 80 and over; cancer; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - therapy; ductal; Elderly;Management; Geriatric Assessment; Humans; Middle Aged; Pancreatic; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - therapy; Patient Selection; Risk Factors; Topic Highlight; Treatment; Treatment Outcome; Treatment; Management; Elderly; Pancreatic cancer; Pancreatic ductal adenocarcinoma
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v22.i2.764

Currently, pancreatic adenocarcinoma mainly occursafter 60 years of age, and its prognosis remains poor despite modest improvements in recentdecades. The aging of the population will result in arise in the incidence of pancreatic adenocarcinomawithin the next years. Thus, the management ofpancreatic cancer in the elderly population is gainingincreasing relevance. Older cancer patients representa heterogeneous group with different biological,functional and psychosocial characteristics that canmodify the usual management of this disease, includingpharmacokinetic and pharmacodynamic changes,polypharmacy, performance status, comorbidities andorgan dysfunction. However, the biological age, notthe chronological age, of the patient should be thelimiting factor in determining the most appropriatetreatment for these patients. Unfortunately, despitethe increased incidence of this pathology in olderpatients, there is an underrepresentation of thesepatients in clinical trials, and the management of olderpatients is thus determined by extrapolation from theresults of studies performed in younger patients. Inthis review, the special characteristics of the elderly,the multidisciplinary management of localized andadvanced ductal adenocarcinoma of the pancreasand the most recent advances in the management ofthis condition will be discussed, focusing on surgery,chemotherapy, radiation and palliative care.