Geriatric Oncology
patient to tolerate certain intensive forms of therapy. The multiple medical problems that affect the older population and the use of related medications to manage them must also be considered.
Particularly important in the elderly MDS patient is the evaluation of the age-related decline in normal bone marrow function, including diminished capacity for response to stressors such as infections or myelosuppressive treatments.
Further observation may be useful to determine whether the patient has an indolent or progressive course, and to evaluate whether the MDS presents as isolated but persistent mild anaemia or as a more progressive and aggressive anaemia state that accumulates excess blasts in the marrow and leads to fatal AML. Therefore, patients may be categorised by age, co-morbidities and by stable versus unstable disease before suggesting specific treatment approaches.
To improve access to treatment, emphasis must be placed on oral therapies that can be easily administered in the outpatient setting with growth-factor support to minimize the requirements of transfusions. Intensive efforts are required to find strategies that keep elderly patients functional and in their homes during treatment, minimising time in hospital.
Careful evaluation of functional status, the ability to tolerate treatments, the effects of disease progression and general overall health can provide the best opportunity for support of older patients, considering that palliative and supportive care represent important components to maximising quality of life. n
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Roberta Ria is a University Researcher in Internal Medicine at the University of Bari. His research fields include multiple myeloma and related malignancies, myelodysplastic syndromes, angiogenesis and tumour progression and connective tissue diseases. Dr Ria received his medical and post-graduate degree in Medical Oncology from the Faculty of Medicine and Surgery at the University of Bari.
Michele Moschetta is a Visiting Scientist in the Department of Oncology at the Mario Negri Institute for Pharmacological Research in Milan. His research areas include multiple myeloma and related malignancies, angiogenesis and tumour progression and translational research. Dr Moschetta received his medical degree from the University of Bari. He is now pursuing a post- graduate degree in medical oncology.
Antonia Reale is a Fellow of Collaborative Research in the Department of Biochemical Sciences and Human Oncology at the Section of Internal Medicine and Clinical Oncology at the University of Bari. Her research fields include multiple myeloma and related malignancies, angiogenesis and antiangiogenesis, angiogenesis and tumour progression, bone marrow angiogenesis and myeloma progression.
Angelo Vacca is a Full Professor of Internal Medicine and Director of the Unit of Clinical Immunology at the University of Bari Medical School. His research fields include angiogenesis and tumour progression, multiple myeloma and related malignancies.
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