AUDIO: 

All too often, health-care professionals ask elderly patients too few questions. At the recent International Society of Geriatric Oncology meeting in The Hague, a study was described in which one question was asked of 240 elderly cancer patients: Do you often feel depressed or sad? Only 50 of them answered yes. But when the same patients were asked more probing, detailed questions, at least a dozen more were found to be depressed. The single question was insufficiently sensitive.

Those treating elderly cancer patients realize that the older a person gets, the more likely loneliness may become a factor to reckon with. For those who have outlived friends and family or else live too far for regular contact, the hospital and medical staff may become the only network left.

Detailed questions, posed by a caring, knowledgeable team, are necessary to understand exactly what the elderly patient wants and expects. For an elderly patient with incurable lung cancer the issue is how to balance a potential small increase in survival time against treatment toxicity. I have had patients who have asked for less aggressive therapy and improved quality of life, even for a limited time. Virtually all patients will accept treatment if they know it will give them improved quality of life without undue toxicity.

Ideally, these are decisions that should be made by the doctor and patient working in concert. European geriatric oncologists report that, all too often, elderly cancer patients do not wish to participate actively in making their own decisions. At the conference, the physicians referred to their elderly patients as “the silent generation,” men and women who are accustomed to deferring to authority. The introduction of American baby boomers into the field, both as sons and daughters of elderly patients and then, in a few years, as the elderly patients themselves, will undoubtedly make this general passivity a thing of the past.

The recent good news that cancer mortality has dropped dramatically in the United States is good news for the geriatric population as well.

One must remember that more than 50% of cancers are diagnosed in the elderly.  This means that geriatric mortality is in decline.  The reasons are several:

First, despite arguments to the contrary, many older people are participating in cancer screening.  They are getting mammograms and colonoscopies well into their eighties and even nineties.  Interestingly, one geriatrician asked me recently at what age I would discontinue routine mammograms.  My response was — never!  Mammograms are a non-invasive and effective way of detecting a bad disease, allowing for early treatment, even if the choice of treatment is non-aggressive.  I would say the same for colonoscopies.

As the elderly participate in screenings, their cancers are being detected sooner, and are potentially curable.

A second, important reason that mortality is declining has to do with more effective treatment options, especially for breast, colon, and prostate cancers, along with myeloma and lymphoma–all of these malignancies common in the elderly.

We need to redouble our efforts to convince the elderly that they should be screened, and once a cancer is detected, carefully assessed for proper treatment options.

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The essential ingredient in determining how to care for the geriatric oncology patient is the full assessment, aimed at maintaining quality of life, evaluating potential toxic risks, and carefully planning specific measures such as dosage adaptation.

The geriatric oncologist must be aware of other issues as well: the fact that, as a person ages, the body’s metabolism slows down, making effective cancer treatment for the elderly a challenge similar to that faced by the pediatric oncologist; the different stages of disease at which patients present and the chemo-sensitivity of the tumor; new drugs and treatment modalities; and, especially important, an awareness of the individual patient and his preference for active treatment.

According to many nutritionists, more than half of all elderly people suffer from some sort of malnutrition. This can be caused by the body’s slowing metabolism, by a loss of taste and thirst, poor absorption of nutrients, and especially dental issues, such as poor-fitting dentures that can make eating a painful chore.

Too few doctors, including regular oncologists, are ready or able to provide the expertise needed to deal with these issues of the elderly cancer patient. Geriatric oncologists know that only a team, including nutritionists, dentists, social workers, pain specialists, can accomplish the goal of seeing our patients gain functional improvement and symptom amelioration such that they can leave the hospital and, if possible, return home.

Transcript also available here: http://www.geriatriconcology.org/

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No one with a child who has suddenly been diagnosed with cancer would dream of consulting a regular oncologist. Distraught parents rightly seek out the best pediatric oncologist they can find. At the other end of the age spectrum are older adults who also deserve age-appropriate specialists. With the aging baby boomer population about to take its place among those most apt to develop cancer, geriatric oncology is coming into its own.

Media-hype notwithstanding, cancer is still primarily a disease of older people. According to the latest statistics, those over 65 account for 60 percent of all new cancers. Barring a sudden, miraculous breakthrough, this means those who were born in 1946–the oldest of the baby- boomers–are about to become part of a cancer epidemic.

As things stand now, cancer care may not be ready for them. The medical community, which has been responsible for wonderful new cancer drugs and treatments, has still not defined optimal protocols for most older oncology patients. This is especially true for those patients who are over 80, seniors we have termed the oldest-old.

Most researchers appear uninterested in this segment of the population. Clinical trials for cancer treatments often exclude patients over 70. Medical personnel are, for the most part, taught that elderly cancer patients are too frail, too ill, and too cognitively impaired to withstand treatment. According to this formula: why treat if drugs and therapies are simply going to make the patient sicker while prolonging the inevitable and, in the end, not result in any benefits?

These assumptions are not only untrue, they have impeded research, education, care, and public policy that must be updated and then implemented if we are to acknowledge the unique needs of older adults with cancer.

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September 19, 2007, Hackensack, NJ - Richard J. Rosenbluth, M.D., chief of the Division of Geriatric Oncology at The Cancer Center at Hackensack University Medical Center, has been invited to join the editorial board of a new medical journal, The Journal of Pain Management. The publication, which is expected to have its first issue ready by early 2008, will present research papers in the areas of pain management and palliative care.

In addition to Dr. Rosenbluth, the editorial board of The Journal of Pain Management comprises medical specialists from all over the world. The editor is Dr. Patricia Schofield of the University of Aberdeen in Scotland. A hematologist/medical oncologist, Dr. Rosenbluth has been chosen to review papers for submission that address cancer pain specifically.

“This is an honor for The Cancer Center to be represented by Dr. Rosenbluth in this new journal,” says Andrew L. Pecora, M.D., chairman and executive administrative director of The Cancer Center. “Dr. Rosenbluth has been a distinguished member of our cancer team for more than 30 years. His expertise in pain management and palliative care will be instrumental in choosing the best papers to be featured in this journal and shared throughout the world.”

Dr. Rosenbluth, a resident of Englewood, NJ, leads the Division of Geriatric Oncology at Hackensack University Medical Center, one of 14 focused divisions that make up The Cancer Center. The division integrates cancer care services for patients over age 65, who make up the largest population of persons affected by cancer. The Division’s Geriatric Oncology Program meets weekly and addresses the unique needs of elderly patients with all kinds of cancer, such as adjustments to standard treatment methods that may need to be made because of patients’ frailty and other medical conditions, medication interactions, rehabilitative needs, transportation issues, financial concerns, pain control, support systems, fatigue, cognitive difficulties, and the need for services to be centralized to avoid multiple trips to doctors and other healthcare providers. Patients are evaluated by a team of geriatric professionals ó including geriatricians, cancer specialists, social workers, and nurses ó who perform an extensive assessment of the patient in order to develop an individualized treatment plan.

The Cancer Center at Hackensack University Medical Center has an active pain management program and extensive palliative care services. Palliative care addresses not only end-of-life issues but attempts to ease pain and discomfort for patients with all types of diagnoses. Dr. Rosenbluth is medical director of Hackensack University Medical Center’s hospice program, which provides a host of medical, nursing, and support services for terminally ill patients and their families.

“I look forward to serving on the editorial board of The Journal for Pain Management and contributing to the body of knowledge that is out in the medical community about pain relief methods and palliative care,” says Dr. Rosenbluth.

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My name is Dr. Richard J. Rosenbluth, and today I am launching my new blog devoted to senior adults who have been diagnosed, or been dealing with cancer, and their families who support and in many cases take care of them. Unfortunately, for many seniors with cancer, the road through our current healthcare system will more often than not be more difficult than it ought to be. That is because, from research, to pharmaceuticals, to cancer care, senior adults are largely overlooked or ignored. They are seen as too frail to receive chemo drugs, or to be able to benefit from aggressive treatments. And quite often this is simply not the case. It is my belief, and the belief of others who work in my field of Geriatric Oncology, that cancer patients should be seen as individuals, and not as a member of a class, and bound in with stereotypes attatched to such a class that prevent them from receiving the very best care available. I and my colleagues are working hard to change both perceptions–in blogs such as this one–and in our professions, to better the quality of cancer care that senior adults receive. I look forward to sharing my thoughts on these matters, and hearing yours as well. Medical colleagues, patients and their families are all welcome to participate in the Seniors With Cancer blog.

And now, an obligatory disclaimer:

This blog does not provide medical or any other health care or fitness advice, diagnosis, or treatment. The blog and its services, including the information above, are for informational purposes only and are not a substitute for professional medical or health advice, examination, diagnosis, or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment, or making any changes to existing treatment. Do not delay seeking or disregard medical advice based on information on this site. Medical information changes rapidly and while Seniors With Cancer and Dr. Richard J. Rosenbluth make efforts to update the content on the site, some information may be out of date. No health information on this blog, is regulated or evaluated by the Food and Drug Administration and therefore the information should not be used to diagnose, treat, cure, or prevent any disease without the supervision of a medical doctor