It was not so long ago that an elderly person suffering from cancer would have received limited treatment and been sent home to die.
"The common thoughts used to be that it wasn't worth treating cancer in older patients; that they'd lived their lives; they might be dying anyway; they couldn't tolerate the treatment; the treatment might adversely affect their quality of life; or that they didn't want to live with the side effects of treatment," said Gary Shapiro, MD, chairman of the department of oncology at Johns Hopkins Bayview and co-founder of its Geriatric Oncology program.
That would not have been particularly good news to people like Charlotte, an 83-year-old local woman who five years ago was diagnosed with breast cancer. Today, after surgery and chemotherapy, Charlotte remains in remission and lives an active live that includes traveling, taking adult education classes, gardening and spending quality time with her children and grandchildren.
Nor, would it have been good news to a neighbor of Charlotte's, 91-year-old Gordon, who was diagnosed with prostate cancer when he was 85. In the past, the philosophy was that with a slow growing tumor like this, there would be no reason to intervene. Gordon's physician, however, convinced the tumor was aggressive, suggested an intensive protocol of radiation. Six years later, he is still driving, playing an occasional round of golf and competing in bridge tournaments.
When Charlotte was first diagnosed with cancer, her children's first thought was that they didn't want to put their mother through any rigorous regimen that would affect her quality of life. Only after the oncologist, who had considerable experience in working with geriatric patients, assured them that he thought Charlotte was healthy enough to cope with the treatment and had a good prognosis, did they feel comfortable with having her undergo treatment. Gordon's children were equally concerned about their dad having radiation. He tolerated the treatments well and has not looked back since.
A Disease of Aging
Cancer can strike anyone at any age, but it is considered a disease of aging. The average age of those diagnosed with all types of cancer is 70. Certain cancers, such as breast, colon, prostate, pancreatic, lung, bladder and stomach cancer, are linked to aging. For lung cancer, for example, the average age of onset is 72; for colon cancer it's 71; breast cancer is 68. These statistics notwithstanding, relatively little is known about how cancers develop and progress in older patients or how best to treat them.
What is known is that recent research has shown that many older cancer patients can tolerate more aggressive treatment than they have typically received. Yet, this group of cancer patients has not been studied in proportion to its size so there is still a dearth of information in understanding the functional, physical, mental, pharma-therapeutic and socio-economic factors that affect the course of disease and outcome of treatment decisions.
In many cases, older people with cancer present with other medical conditions as well. They may have heart disease or diabetes, for example, and the cancer may impact those problems, and conversely.
When it comes to treatment for cancer, older adults:
• May be less tolerant of certain cancer treatments
• Have a decreased reserve (i.e. a capacity to respond to disease and treatment)
• Have other medical problems that also need to be treated
• Have functional problems, such as memory loss or an inability with the ADLs.
• May lack any support network
Additionally, medical professionals need to take into account an older patient's susceptibility to falling and breaking a hip, which can greatly compromise cancer treatment. This may mean the need to prescribe physical therapy to increase strength and reduce risks with a patient who may become weaker as a result of treatment.
Similarly, nutrition may pose a problem when it comes to tolerating certain types of treatment. A dietitian may need to create a nutrition program to boost the patient's health status prior to any intervention. A home care professional may be needed to take care of the patient until treatment is completed, particularly for those without any family caregivers living nearby.
Yet, all this notwithstanding, cancer survivors like Charlotte and Gordon, who are both living full lives, are testaments to the need not to write off geriatric cancer patients, but rather to make sure they receive comprehensive assessments in developing the right care plan once they've been diagnosed.
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