Treatment options for older people diagnosed with cancer

There will be about 1.7 million people newly diagnosed with cancer in 2018, many of whom will be elderly. And that can be a problem, because elderly people may actually not be receiving the most effective cancer treatment they need.

Treating older patients is a topic of discussion at oncology conferences and meetings across the country, informed by retrospective analyses of senior citizens who have had cancer treatment in the past. For example, more than 75 percent of people 65 years of age and older (half of whom are 74+) are rarely accepted into clinical trials.

So, what’s the problem?

One issue is that many older adults are poorly managing one or more existing chronic conditions like heart disease, diabetes, COPD, obesity and hypertension, so physicians are not confident that a newly diagnosed patient will benefit from cancer treatment and may not be able to manage one more treatment regiment.

Another problem is that oncologists don’t always properly assess an older newly diagnosed cancer patient. Doctors are supposed to look at what’s called the “performance status” of the patient. For example, an 80-year-old man might be as physically fit as someone 65 years of age—exercising daily, blood pressure in control, cholesterol in normal range, no other medical issues other than arthritis—yet based on his age alone, he may not be offered treatment. Today there are risk assessment tools the oncologist can use to determine how well a patient would tolerate various treatments. Though it’s certainly true that drugs, such as chemotherapy, have side effect and aren’t risk free, they can be tolerated quite well by most elderly patients who remain active and have their other illnesses and disorders in check. There are also myriad treatments specifically designed to reduce or treat side effects should they occur.

That said…here’s what you need if you are over age 64 and newly diagnosed with cancer:

1. An oncology nurse navigator to serve as your patient advocate. This includes your Work Stride nurse navigator as well as someone within the cancer center where you treatment will take place to serve in a clinical navigation role for you.
2. A multidisciplinary approach to your care. This includes surgical oncology, medical oncology, radiation oncology, radiology, genetics, rehabilitation, nutrition, psychotherapy, navigation, and survivorship care. All of these providers should work as a team that gets to know YOU and not just your cancer diagnosis.
3. Your family doctor. No provider knows you as well as your primary care physician (PCP) who has been managing your chronic illnesses, preventative care, and acute disorders like colds and the flu. She or he shoud be incorporated as a member of your multidisciplinary cancer care team.
4. An appropriate and comprehensive evaluation of your overall health status. In order for you to get the best treatment, your care team should also evaluate disorders that you are at risk for developing, such as diabetes, and consider them with all of the known findings.
5. Getting the right referrals. When you are initially diagnosed, it’s common to get a referral for a second opinion. But you also can ask for referrals to other types of health care providers throughout your treatment so that you can maximize your energy, minimize your side effects, and continue to do both your routine activities as well as those you enjoy.

If these things do not appear to be happening, talk with your Work Stride oncology nurse navigator. She can find out what resources and services are available to you at the cancer facility you have chosen for your treatment.

And remember, you are far more than your age and your biopsy results.

(Lillie D. Shockney, R.N., B.S., M.A.S.)