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LOS ANCIANOS CON NEOPLASIAS DE CABEZA Y CUELLO NO RECIBEN EL TRATAMIENTO ADECUADO

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Estos pacientes a menudo no reciben tratamiento adecuado por razones distintas de la comorbilidad. Dado que el impacto de la terapia sobre la calidad de vida es similar al de sujetos más jóvenes, debe considerarse el tratamiento estándar si no existen comorbilidades graves.
derks9.jpg Autor:
Wynia Derks
Columnista Experto de SIIC

Institución:
Onze Lieve Vrouwe Gasthuis

Artículos publicados por Wynia Derks
Recepción del artículo
31 de Julio, 2007 		Aprobación
27 de Septiembre, 2007
Primera edición
6 de Abril, 2009 		Segunda edición, ampliada y corregida
7 de Junio, 2021

LOS ANCIANOS CON NEOPLASIAS DE CABEZA Y CUELLO NO RECIBEN EL TRATAMIENTO ADECUADO

Resumen
Los pacientes ancianos con neoplasias de cabeza y cuello a menudo no reciben el tratamiento adecuado. Muchos trabajos muestran que se puede realizar el tratamiento quirúrgico radical sin peligro en pacientes ancianos siempre que no existan otras enfermedades asociadas. La radioterapia es tolerada muy bien incluso por los muy ancianos. Los datos sobre quimiorradioterapia combinada en esta población son muy escasos. La comorbilidad grave influye en la tasa de complicaciones posoperatorias y puede limitar la tolerancia a la quimioterapia. Una evaluación minuciosa del estado de salud del paciente previa al tratamiento y la optimización de su estado clínico son fundamentales en los ancianos. Sin embargo, en un análisis multivariado se demostró que incluso después de corregir la comorbilidad y otros factores, se mantenía el efecto de la edad sobre la elección del tratamiento. Las opiniones personales de los cirujanos de cabeza y cuello, los pacientes y sus familiares acerca de la tolerancia al tratamiento y la calidad de vida posterior pueden influir en la elección de la terapia. No obstante, un estudio de calidad de vida mostró que el impacto del tratamiento sobre la calidad de vida no difería entre los pacientes más jóvenes y más ancianos con cáncer de cabeza y cuello. Las presunciones erróneas de que "los ancianos son menos capaces de afrontar un tratamiento mayor" no deben jugar un papel en la elección terapéutica. Siempre se debe considerar el tratamiento estándar si no existen contraindicaciones graves.

Palabras clave
ancianidad, neoplasias de cabeza y cuello, comorbilidad, complicaciones posoperatorias, calidad de vida


Artículo completo
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Age alone should not be a reason for substandard treatment in patients with head and neck cancer; a review of literature

Abstract
Elderly patients with head and neck cancer often receive substandard treatment. Numerous publications have shown that radical surgical treatment can be performed safely in elderly patients provided there is no severe comorbidity. Radiotherapy is tolerated very well even in very old patients. Data about combined chemoradiotherapy in the elderly are scarce. Severe comorbidity influences the rate of postoperative complications and can limit tolerance of chemotherapy. A thorough pre-treatment evaluation of a patient's health status and optimization of the patient's medical condition is crucial in elderly patients. However, in a multivariate analysis it was shown that even after correction for comorbidity and other factors, the effect of age on treatment choice remained. Personal opinions of head and neck surgeons, patients, and their family about treatment tolerance and quality of life after treatment can influence choice of therapy. Yet, a quality of life study showed that the impact of treatment on quality of life did not differ between younger and older patients with head and neck cancer. Mistaken assumptions such as "the elderly are less able to cope with major treatment" should not play a role in treatment choice. Standard treatment should always be considered if no severe contraindications exist.

Key words
elderly, head and neck neoplasms, comorbidity, postoperative complications, quality of life


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Especialidades
Principal: Geriatría
Relacionadas: Cirugía, Medicina Interna, Oncología, Otorrinolaringología, Salud Pública



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Wynia Derks, Department of Otorhinolaryngology, 1090 HM, P.O. Box 95500, Amsterdam, Países Bajos
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