Management of the gastrointestinal side effects of therapy in older adults with cancer

The treatment of cancer often leads to gastrointestinal (GI) side effects. There are few dedicated studies to guide therapy and management of toxicity in elderly patients who are receiving cancer therapy. Consequently, conclusions regarding symptomatic management of GI-related adverse events are largely derived from subset or pooled analyses. The need for supportive cancer care in this population equals or exceeds that of the younger patient. The burden of a cancer diagnosis, treatment, and potential toxicities of therapy can deplete the limited physical, emotional, and financial reserves of an older patient, especially a frail one. Even a seemingly robust older patient may show a more rapid decline compared to a younger individual receiving similar therapy. The volume of information from clinical trials concerning the toxicity of cancer therapy in older adults is limited. Many trials have had limited enrollment of elderly patients or an age cutoff between 60 and 70 years; extrapolation of these data to an older age group may not be appropriate. Use of post hoc subset analysis from larger studies may produce selection bias, and individuals enrolled in clinical trials are often more medically fit than the general population of older adults and as such are not representative. Despite these limitations, a number of conclusions about managing GI side effects of cancer therapy can be derived from available data.