Managing myelodysplastic symptoms in elderly patients

R Ria, M Moschetta, A Reale, G Mangialardi, A Castrovilli, A Vacca, F DammaccoDepartment of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, ItalyAbstract: Most patients with myelodysplastic syndromes (MDS) are elder...

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Autores principales:	R Ria, M Moschetta, A Reale, et al
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2009
Materias:	elderly myelodysplastic syndromes novel agents supportive-care treatment strategies. Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/6cfda2c817dd4ff2b08d5b9f45291c35
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spelling	oai:doaj.org-article:6cfda2c817dd4ff2b08d5b9f45291c352021-12-02T08:52:02ZManaging myelodysplastic symptoms in elderly patients1178-1998https://doaj.org/article/6cfda2c817dd4ff2b08d5b9f45291c352009-10-01T00:00:00Zhttps://www.dovepress.com/managing-myelodysplastic-symptoms-in-elderly-patients-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998R Ria, M Moschetta, A Reale, G Mangialardi, A Castrovilli, A Vacca, F DammaccoDepartment of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, ItalyAbstract: Most patients with myelodysplastic syndromes (MDS) are elderly (median age range 65 to 70 years); as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone marrow function, including the diminished capacity of response to stressors such as infection or myelosuppressive treatments. Through the integration of geriatric and oncological strategies, a personalized approach toward this unique population may be applied. As with many diseases in the elderly, reliance on family members or friends to maintain the prescribed treatments, including travel to and from appointments, may place additional stressors on the patient and his/her support network. Careful evaluation and knowledge of functional status, ability to tolerate treatments, effect of disease progression, and general overall health conditions can provide the best opportunity to support these patients. Immediate assessment of daily living activities may detect deficiencies or deficits that often require early interventions.Keywords: elderly, myelodysplastic syndromes, novel agents, supportive-care, treatment strategiesR RiaM MoschettaA Realeet alDove Medical Pressarticleelderlymyelodysplastic syndromesnovel agentssupportive-caretreatment strategies.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 4, Pp 413-423 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	elderly myelodysplastic syndromes novel agents supportive-care treatment strategies. Geriatrics RC952-954.6
spellingShingle	elderly myelodysplastic syndromes novel agents supportive-care treatment strategies. Geriatrics RC952-954.6 R Ria M Moschetta A Reale et al Managing myelodysplastic symptoms in elderly patients
description	R Ria, M Moschetta, A Reale, G Mangialardi, A Castrovilli, A Vacca, F DammaccoDepartment of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, ItalyAbstract: Most patients with myelodysplastic syndromes (MDS) are elderly (median age range 65 to 70 years); as a consequence, the incidence and prevalence of these diseases are rising as the population ages. Physicians are often uncertain about how to identify patients who may benefit from specific treatment strategies. The International Prognostic Scoring System is a widely used tool to assess the risk of transformation to leukemia and to guide treatment decisions, but it fails to take into account many aspects of treating elderly patients, including comorbid illnesses, secondary causes of MDS, prior therapy for MDS, and other age-related health, functional, cognitive, and social problems that affect the outcome and managing of myelodysplastic symptoms. Patients with low-risk disease traditionally have been given only best supportive care, but evidence is increasing that treatment with novel non-conventional drugs such as lenalidomide or methyltransferase inhibitors may influence the natural history of the disease and should be used in conjunction with supportive-care measures. Supportive care of these patients could also be improved in order to enhance their quality of life and functional performance. Elderly patients commonly have multiple medical problems and use medications to deal with these. In addition, they are more likely to have more than one health care provider. These factors all increase the risk of drug interactions and the consequent treatment of toxicities. Manifestations of common toxicities or illnesses may be more subtle in the elderly, owing to age-associated functional deficits in multiple organ systems. Particularly important to the elderly MDS patient is the age-related decline in normal bone marrow function, including the diminished capacity of response to stressors such as infection or myelosuppressive treatments. Through the integration of geriatric and oncological strategies, a personalized approach toward this unique population may be applied. As with many diseases in the elderly, reliance on family members or friends to maintain the prescribed treatments, including travel to and from appointments, may place additional stressors on the patient and his/her support network. Careful evaluation and knowledge of functional status, ability to tolerate treatments, effect of disease progression, and general overall health conditions can provide the best opportunity to support these patients. Immediate assessment of daily living activities may detect deficiencies or deficits that often require early interventions.Keywords: elderly, myelodysplastic syndromes, novel agents, supportive-care, treatment strategies
format	article
author	R Ria M Moschetta A Reale et al
author_facet	R Ria M Moschetta A Reale et al
author_sort	R Ria
title	Managing myelodysplastic symptoms in elderly patients
title_short	Managing myelodysplastic symptoms in elderly patients
title_full	Managing myelodysplastic symptoms in elderly patients
title_fullStr	Managing myelodysplastic symptoms in elderly patients
title_full_unstemmed	Managing myelodysplastic symptoms in elderly patients
title_sort	managing myelodysplastic symptoms in elderly patients
publisher	Dove Medical Press
publishDate	2009
url	https://doaj.org/article/6cfda2c817dd4ff2b08d5b9f45291c35
work_keys_str_mv	AT rria managingmyelodysplasticsymptomsinelderlypatients AT mmoschetta managingmyelodysplasticsymptomsinelderlypatients AT areale managingmyelodysplasticsymptomsinelderlypatients AT etal managingmyelodysplasticsymptomsinelderlypatients
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Managing myelodysplastic symptoms in elderly patients

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