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