Cancer in the very elderly: Three programs designed especially for frail patients

Cancer in the very elderly: Three programs designed especially for frail patients
Cancer in the very elderly: Three programs designed especially for frail patients

Coping with cancer at any age is difficult enough. Coping with cancer at an advanced age can be really overwhelming. Along with more years come more health problems. Older people are more sensitive to medication and more susceptible to medication reactions. They often have complicating comorbidities and depressive symptomatology. They may have more financial hardship and fewer family and friends for support.

Elderly patients need more intervention from oncology and other health care staff; some hospitals and medical centers have separate departments or staff members to address their needs. This month's column presents three facilities with programs specifically designed to provide care to elderly patients with cancer.

MEMORIAL SLOAN-KETTERING CANCER CENTER

Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City is one facility that has taken special consideration for the geriatric patient with their 65+ Program, which is composed of a multidisciplinary geriatric team. In addition to oncologists, the program employs physicians, nurse practitioners, nutritionists, and even pharmacists who subspecialize in geriatrics. In addition, MSKCC utilizes psychiatrists, nurses, social workers, and specialists in pain and palliative care, rehabilitation, clinical trials, and integrative medicine.

The integrative medicine service uses nonpharmaceutical techniques to enhance the medical cancer treatment. For patients whose age makes them frail and prone to medication sensitivities, these techniques can be especially helpful. Staff members truly treat the total patient with acupuncture and other therapeutic techniques that offer music, massage, mind/body therapies, and yoga. The fitness classes are specifically geared towards the patient of advanced age. Many of the program's services are also available to the patient's family members and caregivers as well. Social workers play an especially important role in the treatment of the very elderly with cancer. Adjustment to a serious illness is always difficult, but for people living alone and who may have difficulty getting out and about on their own, it can be especially difficult. The 65+ Program social work staff ensures that the risk of social isolation does not become a reality as the patient fights his or her illness.

DANA-FARBER/BRIGHAM AND WOMEN'S CANCER CENTER

Specialized oncology services are offered by the renowned Boston, Massachusetts, facility for patients 65 years and older via a program specifically designed to care for older patients with leukemia and related blood disorders. Their multidisciplinary team is composed of a geriatric oncologist as well as oncologists, geriatricians, physician assistants, nurse practitioners, and social workers who subspecialize in treating leukemia in elderly patients. They understand that patients in this age group are more likely to experience complications from treatment as well as from other age-related illnesses they may have.

Reduced-intensity stem cell transplants are among the treatment options that Dana-Farber utilizes for a subset of older patients (aged up to 75 years).1 Another practice employed by Dana- Farber/Brigham and Women's is to base all treatments on the patient's functional age instead of calendar years. They are also respectful of a patient's wish to restrict care to palliation only. In such cases, staff monitors patients, only treating symptoms when necessary. They also enroll patients in clinical trials whenever possible.

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