Older cancer patients can take aggressive treatments
Tampa, Fla—Cancer is a disease of aging yet, often, older adults do not receive the same aggressive treatment as other patients.
“We promote treatment of our seniors, but other things have to be taken into consideration,” said Janine Overcash, PhD, GNP-BC, assistant professor of nursing at the University of South Florida College of Nursing in Tampa. Dr Overcash presented a session at the Oncology Nursing Society's Institutes of Learning.
Dr Overcash maintains that life expectancy or frailty, functional status, and untreated comorbidity, such as hypertension, diabetes, and thyroid problems, should determine cancer treatment rather than age.
“Studies show patients who are older do as well with surgery and chemotherapy as younger people when allowing for functional status and comorbidity,” added Dr Overcash. She cited a 2008 study showing similar response and survival rates in older and younger patients given irinotecan for advanced colorectal cancer. In addition, a 2009 study involving nonsmall cell lung cancer patients found manageable toxicities when older patients received docetaxel and carboplatin.
Clinicians must try to keep elders as healthy as possible while undergoing cancer treatment, indicated Dr Overcash, adding, “Geriatric oncology practitioners have to be in good communication with primary care providers also caring for the same patient.”
Federal data indicated from 2002-2006, the median age at diagnosis for all cancer sites was 66 years, and the median age of death 73 years.
“Cancer does behave differently in older people,” Dr Overcash reported. She offered as example the variances between pre- and postmenopausal breast cancers and the greater aggressiveness of acute myelogenous leukemia in older adults.
In many older cancer patients, pain goes unrelieved, Dr Overcash said. Studies also indicate providers often underprescribe opioids in senior patients.
Older adults' social support also differs from younger patients. Elders often live alone, have transportation issues that make it difficult to get to treatment appointments, and an informal support system. Neighbors may provide the primary support.
“We have to take special care and address who is driving them to appointments and if they have help [at home] if they cannot care for themselves,” Dr Overcash said. “We have to be proactive in identifying the social support and how much that person can lend.”
Dr Overcash advises nurses to use the ConsultGeriRN.org online instruments to assess older adults and determine support systems, limitations, functional status, depression, cognition, and other comorbidities.
“We may not have a perfect plan, but at least it becomes part of the discussion,” Dr Overcash said. “Then people can start thinking about what they can do in case they need it, not the night they [require assistance].”