Gero-Oncology: Preparing for the Coming Wave of Elderly Cancer Patients
evaluation of an older patient with cancer.
A growing proportion of cancer patients are elderly — creating a demographic shift with important implications for cancer care, including radiotherapy. Integrating geriatric care into oncology nursing has never been more important.
As baby boomers age, the number of elderly patients with cancer will climb, as will the proportion of cancer patients who are elderly.1-4 By one estimate, a 67% increase in cancer incidence among adults older than 64 years will occur between 2010 and 2030, and the proportion of all cancers diagnosed in these older adults will have climbed from 61% to 70%.5
This shift has important implications for cancer care and oncology nursing, prompting experts to intensify calls for the wider integration of geriatric medicine into oncology care, including gero-oncology nursing.1,2,4,6-8 And efforts are under way to share knowledge and foster coordination between the geriatric and oncology nursing disciplines.2
Cancer management is often complex for patients who are elderly, as they are more likely than younger patients to have frailty and polypharmacy issues, lower tolerance for radiotherapy and chemotherapy toxicity, and more and different comorbidities.3,4,6,9,10 Fatigue and pain are also overriding problems among elderly cancer patients.7 And social, financial, and quality of life issues are additional factors that can distinguish elderly from younger patients with cancer.7
Oncology Nursing: Front and Center in Gero-Oncology
The emerging field of gero-oncology involves increased awareness among geriatric nurses and health care providers about cancer prevention, screening, and early diagnosis, as well as increased appreciation among oncology specialists of the unique challenges of caring for elderly patients.11
Oncology nurses play a key role in preserving elderly patients' autonomy and quality of life and in educating these patients about how to ask oncologists about the comparative risks and benefits of available treatment options, as well as frank appraisals of prognosis.12
Nursing efforts can be complicated by communication challenges among elderly patients, ranging from declines in hearing acuity to attention and neurocognitive issues that can impair comprehension and recall and, therefore, patients' ability to comply with instructions and treatment plans. These issues, combined with physical frailty, can often increase elderly patients' levels of dependency on caregivers and members of their cancer care team. Oncology nurses are well positioned to help maintain as much of elderly patients' independence and autonomy as possible.2
Recognition of problems commonly seen among the elderly should not reinforce ageist bias or the assumption that all elderly patients face poor prognosis or are not candidates for aggressive cancer treatment where appropriate.13 Functional and chronological age may differ in elderly patients, so patient tolerance of, and potential benefits from, treatment should be assessed, not assumed.14