¿Reciben un tratamiento adecuado los pacientes ancianos con cáncer? / Do elderly patients with cancer receive appropriate treatment?

Alrededor del 60% de todos los cánceres y del 70% de los fallecimientos por esta causa ocurren en personas de más de 65 años. Sin embargo, distintos estudios demuestran los peores resultados terapéuticos obtenidos en estos pacientes. La causa de estos peores resultados no parece derivarse de una peor evolución del cáncer. Los ancianos están claramente poco representados en los ensayos clínicos y existe una evidente actitud abstencionista hacia el tratamiento por parte de los profesionales involucrados en el manejo del cáncer en estos pacientes. Presentamos 3 casos clínicos de pacientes geriátricos remitidos a nuestra unidad para control paliativo de su sintomatología y que en realidad necesitaban tratamientos más agresivos. A propósito de estos casos, comentamos las diferencias existentes respecto a las distintas modalidades de tratamiento en oncología entre la población adulta y la geriátrica. Estas diferencias no dependen tanto del propio cáncer o de la aplicación del tratamiento como de circunstancias asociadas, es decir, principalmente de la presencia de comorbilidad, deterioro funcional o síndromes geriátricos. Por último, tratamos de establecer unas recomendaciones generales a la hora de la evaluación de un anciano con cáncer

Around 60% of all cancers and 70% of cancer-related deaths occur in the population aged over 65 years. However, various studies show that therapeutic results in this kind of patient are poorest. The cause of these poor results does not seem to be a more aggressive cancer course. The elderly are clearly underrepresented in cancer treatment trials and there is a clear abstentionist attitude towards treatments among professionals involved in cancer management. We present three geriatric patients who were referred to our unit for palliative care and who in fact deserved more aggressive treatments. Apropos of these patients, we discuss differences among the distinct treatment modalities in oncology for the adult and geriatric populations. These differences do not depend so much on the cancer itself or on the application of treatment but rather depend on associated circumstances, mainly the existence of comorbidity, functional deterioration or geriatric syndromes. Lastly, we try to establish several general recommendations for the proper evaluation of elderly individuals with cancer

[Eosinophil cationic protein in the asthmatic infant: correlation with the clinic and pulmonary function]. / Proteína catiónica del eosinófilo en el asma infantil. Correlación con la clínica y función pulmonar.

PATIENTS AND METHODS: Serum eosinophil cationic protein (ECP) was measured in 99 chronic asthmatic patients (51 males and 48 females) with a mean age of 10.59 years and correlated with the number of eosinophils, lung function, symptoms in the last 6 months and clinical scoring (that reflecting the clinical situation during the last 15 days). RESULTS: Serum ECP showed a significant correlation with the total number of eosinophils (p < 0.001, R = 0.44), clinical scoring (p < 0.05, R = 0.26), number of inhaled beta 2-agonist doses needed in the last 15 days (p < 0.05, R = 0.26), forced expiratory volume during 1 second (FEV1; p < 0.01, R = -0.27), forced vital capacity (FVC; p < 0.05, R = -0.23), maximal mid-expiratory flow (FEF25-27; p < 0.001, R = -0.37). However, there was no significant correlation between the total number of eosinophils and the clinical situation of the children or the FEV1, but we found a significant correlation with the FEF25-27. Patients with ECP < 20 had better results on lung function tests than patients with ECP > 20 (FEV1: 108.89 +/- 17.7 vs 100.5 +/- 22 (p < 0.05), FEF25-27: 93.81 +/- 24.4 vs 75.21 +/- 24.5 (p < 0.001). CONCLUSIONS: The findings of this study suggest that the ECP level is a good marker of the situation of asthma in childhood. The levels of ECP will probably be able to help us to evaluate the degree of bronchial inflammation that neither the clinical state nor the lung function define completely.