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Geriatric Oncology pp 1–28Cite as

Multidisciplinary Management of Liver, Pancreatic, and Gastric Malignancies in Older Adults

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Abstract

Liver, pancreatic, and gastric cancers are aggressive and common malignancies and their incidence is increased in the elderly. Treatment requires a multidisciplinary approach involving multiple specialties including gastroenterology, surgery, radiation oncology, interventional radiology, and medical oncology. Appropriate management is limited by inherent biases among clinicians and the fact that very few clinical trials enroll elderly patients. It is well documented across multiple malignancies that elderly patients often receive substandard care, are denied potentially curative surgery, and are less likely to be treated with standard of care chemo- and radiation-therapies. However, it is clear that chronological age should not be used as the sole determinant when formulating a treatment strategy. Various tools included within a Comprehensive Geriatric Assessment are available and can aid in the decision-making process, when considering the best treatment for patients with advanced age.

Mounting data support the argument that elderly patients derive somewhat similar benefit from treatment compared with younger patients. Surgical complications and toxicities with chemotherapy may be higher in elderly population because of associated comorbidities, diminished functional status, and altered pharmacokinetic profiles. Increased clinical trial accrual of elderly patients is needed and can help provide data to guide management of these complex patients. In the following chapter, we evaluate the multidisciplinary management of liver, pancreatic, and gastric cancer in the elderly with a focus on evidence based, patient-centered treatment strategies.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA

    Danielle K. DePeralta, Jessica Frakes, Nadia Saeed, Kaldhoun Almhanna, Richard Kim & Daniel A. Anaya

  2. Department of Radiation Oncology, H. Lee Moffitt Cancer Center& Research Institute, Tampa, FL, USA

    Jessica Frakes & Nadia Saeed

  3. Department of Oncology, Mayo Clinic, Rochester, MN, USA

    Amit Mahipal

Authors
  1. Danielle K. DePeralta
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  2. Jessica Frakes
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  3. Amit Mahipal
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  4. Nadia Saeed
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  5. Kaldhoun Almhanna
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  6. Richard Kim
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  7. Daniel A. Anaya
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Correspondence to Daniel A. Anaya .

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  1. Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA

    Martine Extermann

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  1. Department of Medical Oncology, Institut Curie, Saint-Cloud, France

    Etienne Brain

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DePeralta, D.K. et al. (2019). Multidisciplinary Management of Liver, Pancreatic, and Gastric Malignancies in Older Adults. In: Extermann, M. (eds) Geriatric Oncology . Springer, Cham. https://doi.org/10.1007/978-3-319-44870-1_28-1

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