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Confronting Cancer as a Senior Adult

Factors to Consider While Making Treatment Decisions

by Amy MacKenzie, MD, and Andrew E. Chapman, DO, FACP

Knowledge image

Making treatment decisions can be challenging. Meeting with multiple specialists to discuss everything from chemotherapy to sur­vivorship plans is an overwhelming part of the cancer experience for anyone diagnosed with cancer. However, if you’re a senior adult, you also have a unique set of challenges to consider as you work with your healthcare team to plan your treatment.

One Size Doesn’t Fit All
Your course of treatment should not be chosen based on your age alone. Some cancer survi­vors aged 65 years and older are quite fit and healthy. Others may have illnesses that can complicate cancer treatment. Thus, the best course of treatment for one person might not be right for another. In addition, seniors are often worried about how their partner will cope, how much treatment will cost, which side effects they could ex perience, and how to get to and from the treatment center. These concerns may factor into your treatment plan.

An emerging approach to individual­izing cancer treatment for senior adults is the development of specialized senior adult oncology centers. Upon visiting one of these centers, such as the Senior Adult Oncology Center at Thomas Jefferson University in Philadelphia, PA, you will first connect with a senior adult oncology navigator who will guide you through every step of the process. You will then meet with a geriatrician, an oncologist, a registered dietician, a geri­atric pharmacist, and a social worker. Each healthcare professional will spend time with you to assess your cancer diagnosis, as well as any other health problems you may have. You will also have the chance to discuss any concerns you have about treatment.

Your treatment plan should reflect your individual goals, as well as offer symptom relief and, ultimately, remission or cure.

Author of Article photo

Dr. Amy MacKenzie

A Unique Set of Challenges
When making cancer treatment decisions, the following considerations are unique to senior adults:

♦ Life Expectancy This can vary widely, depending on the health of the individual senior. An understanding of a person’s life expectancy, despite his or her can­cer diagnosis, can be incredibly helpful in deciding how aggressive to be with treatment. If a person’s life expectancy is especially limited by another medical problem, such as heart failure, this should be considered in the decision-making process. Above all, your treatment plan should aim to provide some perceived benefit without shortening life.

♦ Comorbidities Some seniors have other medical conditions like diabetes or high blood pressure. These illnesses, called comorbidities, can complicate the treatment decision–making process. Seniors with comorbid conditions can be more sensitive to cancer treatment side effects, and their oncologists will need to adjust their treatment plans accordingly. If the comorbidities are severe, cancer treatment may have to wait until the other medical conditions are treated or under control.

Author of Article photo

Dr. Andrew Chapman

♦ Medications Many seniors are already on multiple medications. It’s important that all the medications a person is taking be considered while making treatment plans because some medications might not be necessary anymore or may interact with cancer drugs. Having a pharmacist as part of the healthcare team is helpful when dealing with multiple medications.

♦ Individual Preferences For senior adults, quality of life may be as impor­tant as, if not more important than, “quantity” of life. A frank discussion with your healthcare team about the risks and benefits of treatment is essen­tial. Your treatment plan should reflect your individual goals, as well as offer symptom relief and, ultimately, remis­sion or cure.

Putting It All Together
In a senior adult oncology center, after you have met with each healthcare provider indi­vidually, the healthcare team will meet to review their findings and put all the pieces together. A thorough review of your health status, medications, social issues, and dietary concerns will be in­corporated into a comprehensive cancer treatment plan. The goal of this plan is to maximize treatment benefit and minimize risk while taking into account your indi­vidual needs and goals. If you are unable to seek a comprehensive evaluation in your area, you can meet with your pri­mary care physician and your oncologist to create a comprehensive treatment plan that addresses the unique considerations covered here. The best cancer treatment plan is one that is patient centered, goal oriented, and team based.

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Dr. Amy MacKenzie is an assistant professor in the Regional Cancer Care Division of the Department of Medical Oncology at Thomas Jefferson University in Philadelphia, PA. Dr. Andrew Chapman is an associate pro­fessor and director of the Regional Cancer Care Division of the Department of Medical Oncology and the cofounder of the Senior Adult Oncology Center at Thomas Jefferson University.

This article was published in Coping® with Cancer magazine, November/December 2014.