The expansion of older population segments and the continuous increase in the incidence of non-Hodgkin’s lymphoma (NHL) makes this group of neoplasms an important and growing problem. Older NHL patients have increased risk of therapy-related toxicity as a result of age-related physiological changes and frequent co-morbidities. A functional assessment of the elderly patient is necessary to determine the likelihood of tolerating and responding to therapy. The comprehensive geriatric assessment (CGA) is one multidisciplinary tool that has been applied successfully to older cancer patients and aids in identification of subjects who will or will not benefit from anti-neoplastic treatment. Although indolent lymphomas present more frequently at advanced stage, randomized trials do not show better outcomes with early therapy, supporting close observation until specific therapeutic indications arise. Use of the monoclonal antibody rituximab as a single agent or in combination with chemotherapy improves survival and has become the standard of care in first-line treatment. Radioimmunoconjugates, bendamustine, and other monoclonal antibodies as well as novel targeted agents also are active against indolent lymphomas. Diffuse large B-cell lymphoma is an aggressive but potentially curable disease. Several trials performed exclusively in elderly patients have demonstrated improved response rates and survival with the addition of rituximab to CHOP (cyclophosphamide, doxorubicin [adriamycin], vincristine, prednisone) chemotherapy in the front-line setting. Salvage chemotherapy followed by autologous haematopoietic cell transplant (autoHCT) has been shown to have better failure-free and overall survival in randomized trials involving younger patients. Highly selected individuals up to age 70 years may attain long-term survival benefit from autoHCT, although transplant-related mortality is higher than in younger patients.
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Doctors often have trouble knowing who might respond to certain cancer treatments. “We kind of give chemotherapy and wish for a good result,” says Dr. Afshin Dowlati. That could change.
Dowlati led a study that revealed lung cancer patients with low levels of a molecule that controls cellular interaction have twice the chance of responding to chemotherapy than those with high levels. Those levels can also predict how likely a patient is to live a year after diagnosis. The difference could help patients decide whether to try chemotherapy, drugs or pursue alternative therapies, Dowlati says.
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Colon cancer is the second most deadly cancer in the U.S. despite being the most preventable. The American Gastroenterological Association (AGA) recently announced concern that people will neglect colon cancer screening during this economic climate.
Screening is recommended in both sexes over age 50 and earlier if a patient has a family history of this disease. However, some people put it off due to fear of having a colonoscopy, which can be both invasive and expensive. As more people lose health insurance coverage, the high cost of this procedure may lead many more people to forego screening.
Sanford Markowitz, MD, CWRUmedicine oncologist and colon cancer researcher of the University Hospitals Ireland Cancer Center at University Hospitals Case Medical Center, has developed a less expensive, non-invasive test for this disease.
About the test:
- The non-invasive test detects DNA markers for colon cancer using a stool sample that is taken at home
- The DNA Stool Test is available now at the doctor’s office, or can be easily ordered by the doctor
- Although the test isn’t covered by insurance, the cost is significantly lower
- Patients with negative results will not need to commit time and money to having a colonoscopy; patients with positive results will move forward with colonoscopy to provide more information
- It is 80 percent effective and while colonoscopy is still the most effective test, it is not useful if patients are avoiding it altogether
- The American Cancer Society added the test to its screening guidelines last year
Learn more at CWRUmedicine.org