Melissa J. Cohen, MD

Osteoporosis in elderly cancer patients is an increasing problem, yet it remains under-recognized and under-managed. We commend Dr. Balducci for writing a comprehensive review of the bone complications associated with cancer and its treatment in the elderly.

The review article by Drs. Gillison and Chatta represents a very nice overview of cancer chemotherapy in the older individual across a number of different tumor types. The authors correctly point out that it is very important to distinguish chronologic from physiologic age, and that older individuals have been historically underrepresented in cancer clinical trials. Many of the larger phase III clinical trials in this population are either not designed or not powered to look at individuals over the age of 70. Moreover, trials that do include older individuals often select for the most functional individuals with minimal competing comorbid conditions and often do not include or report secondary analysis that examines outcomes by age, health status, or a combination of both. As a result, health-care providers face challenges when communicating and selecting treatment options with patients and their companions.