M.D. ANDERSON CANCER CENTER
How old is elderly? According to Holly M. Holmes, MD, practicing geriatrician at University of Texas M.D. Anderson Cancer Center, defining who is elderly is becoming increasingly difficult. The traditional definition of age 65 years as the launch of a person’s elderly years is no longer applicable; we now need to add 10 or 15 years to that threshold. Holmes says now “people who are 75 [years] and older are more likely to have conditions common to the geriatric population.”2
Holmes says the most common reason for bringing her in on a case is polypharmacy, particularly for elderly patients who are already taking eight or nine medications concurrently even before their cancer treatment begins. Taking that many medications alone can cause reactions, interactions, and side effects. Adding cancer treatment on top of that, Holmes explains, the challenge becomes trying to limit the number of medications to decrease side effects and reduce toxicity. As a former pharmacist, the geriatrician is comfortable reviewing a patient’s medication regimen, identifying problems, and coming up with alternatives that reduce the number of drugs the patient is taking. She evaluates everything, including OTC, herbal medicines, and supplements, trying to eliminate any unnecessary drugs, whether they are supplements or medications.2
The oldest patient Holmes has seen at M.D. Anderson was 98 years old. She says the elderly often handle issues related to cancer easier than do younger patients. People of advanced age have usually had other diseases during their lifetimes, and they are able to cope with yet one more health problem quite well. No matter how old patients are, they need to discuss their treatment options with the oncology team. The geriatrician explains, “The question is in the context of their other medical problems, any functional problems, their reserve of social support, their ability to be independent, all of those things have to weigh into their decision for cancer treatment. They really don’t want to base that solely on their numeric age.”2 ONA
Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.
1. Gill S, Porter DL . Reduced-intensity hematopoietic stem cell transplants for malignancies: harnessing the graft-versus-tumor effect. Annu Rev Med. 2013;64:101-17.
2. Old Age and Cancer; MD Anderson Cancer Newsline 11.14.2011. Available at: http://www.mdanderson.org/newsroom/cancer-newsline/cancer-newsline-topics/2011/oldagecancer.html. Accessed June 3, 2013.