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.
First and foremost, we must abolish the notion that all older adults with cancer present with the same physical, psychological, and social needs. Age should be seen as only one dynamic designating a patient’s status, and should never be the determining factor in whether or not to offer treatment. All elderly patients are entitled to a comprehensive geriatric assessment, which should clarify many issues, including other health problems—co- morbidities—such as diabetes, heart disease, hypertension, and respiratory conditions; cognitive deficits in any; and living and social arrangements.
A frail 70-year-old patient with lung cancer and diabetes who lives in a nursing home and has no living relatives may not be as good a candidate for aggressive therapy as an 85-year-old with breast cancer who lives at home with attentive children down the street. Elderly patients who present with grave risk of complications might be candidates for aggressive supportive-care measures.
In general, elderly patients can be categorized as fit, vulnerable, or frail, with the recognition that there is a lot of overlapping. Fit patients with cancer can be treated like all other adults, irrespective of age; vulnerable patients will need adapted regimens and increased surveillance for adverse effects. Sometimes, the best we can do for the frail elderly is intense supportive care. Although at my geriatric oncology practice at HackensackUniversityMedicalCenter, I have known many frail, elderly patients with relatively advanced disease who safely received specific anti- cancer treatment together with more general supportive measures to address all their needs.
Patients over age 75 who are fit tend to do as well as younger patients with standard cancer care treatment. Geriatric oncology brings the critical factors of proper assessment, and a multidisciplinary approach that considers all of the barriers that older patients face when they try to obtain optimal cancer care.