الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cancer is the leading cause of death in women and men aged 60 to 79 years. More than 60% of all cancers and 80% of cancer-related deaths in the United States occur in patients who are 65 years or older. Older individuals are more prone to develop cancer than younger individuals as a result of physiological changes associated with ageing, which in turn favor the development and growth of cancer.
Increased incidence and prevalence of cancer in elderly people and increased life-expectancy of the elderly mean that cancer in older individuals is becoming an increasingly common problem.2
Unfortunately, elderly cancer patients are under-represented in clinical trials for new cancer therapies. Advanced age alone should not preclude the use of effective cancer treatment that could improve quality of life or extend meaningful survival. Proper surgery and adjuvant treatment can decrease relapse and improve survival in some women with breast cancer who are older than 80 years. However, treatment that diminishes quality of life with no significant survival benefit should be avoided. Older patients in good performance status are able to tolerate commonly used chemotherapy regimens as well as younger patients, when adequate supportive care is provided.
Proper selection of patients is the key to administering effective and safe cancer treatment. The challenge of managing the older cancer patient is to assess whether the expected benefits of treatment are superior to the risk in a population with decreased life expectancy and decreased tolerance to stress.
However, chronological age by itself is not reliable in estimating life expectancy, functional reserve, or the risk of treatment complications. This information is best provided by a comprehensive geriatric assessment (CGA),
The administration of the CGA is time-consuming, which limits its use in an outpatient setting. For this reason, alternative screening tools are being evaluated, including an abbreviated model of the CGA, the Barber test, the Vulnerable Elders Survey–13 (VES-13) questionnaire, and G8 screening test. The most important characteristic of a short prescreening tool is its ability to exclude the possibility of vulnerability with a high negative predictive value and positive results that indicate the need for a more complete geriatric evaluation.
In our study a total of 201 patients were randomized; only 138 patients fulfilled the inclusion and exclusion criteria and accepted to be enrolled in the study.
The 138 patients were divided into two groups according to age.
1. Group A included 83 patients < 70 year old.
2. Group B included 55 patients ≥ 70 year old.
All patients underwent VES-13 and G-8 assessment for a period of 6 months starting from October 2011 through March 2012, both screening tools were translated from English to Arabic format in order to facilitate communication with patients.
All patients were assessed regarding the compliance to treatment, protocol of therapy ( Type of chemotherapy, number of chemotherapy cycles, modification of dose ) and side effects as per ECOG common toxicity criteria.
According to VES and G8 scores, 55 and 64 patients were classified as vulnerable respectively. The risk of Group B patients to be vulnerable by VES score as well as by G8 is more than Group A (Odds ratio = 2.445 and 3.721 respectively).
In our study 246 cycles of chemotherapy were taken by the patients above 70 years old, the most common severe toxicities ( grade 3 and 4) observed were Leukopenia (12.2%), Anemia (6.1%), infection (9.3%), Nausea (9.3%), Vomiting (9.8%) and weight loss (9.8%).
In the analysis of the association betw