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Treating Cancer in Older Adults

by Hyman B. Muss, MD

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“I didn’t know older people got cancer.” I hear this frequently from newly diagnosed older adults, who are often surprised to find out that the risk of getting cancer rises dramatically with age. But the fact of the matter is that, thanks to improvements in healthcare, people are living longer, resulting in an increasingly larger population of older Americans and, subsequently, an ever-growing number of older adult cancer survivors.

Currently, in the United States, the average age of someone newly diagnosed with cancer is 67. The problem is that most of what we know about caring for older adults with cancer comes from re­search done on much younger patients. What may be the best treatment for a 40-year-old may not be the best treat­ment for a 75-year-old. Moreover, the goals of treatment may differ according to a person’s age.

Someone who is younger may accept harsher side effects in exchange for small improvements in survival, while someone who is older may focus on maintaining function and living independently for as long as possible. The challenge in taking care of an older adult with cancer is accurately weighing the treatment’s effect on function and independence against its potential benefit in treating their cancer. A cancer diagnosis is scary, but for an older adult with other major illnesses, like heart or lung disease, cancer may not be the primary health concern.

Ask your doctor if he or she is experienced in caring for older adults with cancer and if you would benefit from a geriatric assessment.

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Dr. Hyman Muss

When it comes to making treatment decisions, it’s not your age that matters; it’s how much longer you’ll likely live. Healthcare professionals have a variety of tools that can help them predict an individual’s life expectancy by taking into account other, non-cancer illnesses, as well as functional status. On aver­age, a healthy 65-year-old will live to be 85, a healthy 75-year-old will live to be 87, and a healthy 85-year-old will live to be 91. So for an otherwise healthy 77-year-old who has developed a life-threatening but potentially treat­able cancer, state-of-the-art cancer treatment should be considered. Older adults with cancer who are in good health generally tolerate modern cancer therapies, including surgery, radiation, and even chemotherapy, just as well as younger survivors.

Making decisions is harder when an older individual is diagnosed with a cancer that isn’t curable but is causing side effects, or when that person has a potentially curable cancer in addition to a non-cancer illness that is causing major problems in function and quality of life. In these instances, medical care should be tailored to the individuals’ treatment goals, and the potential for cancer treatment to make a bad situa­tion worse should be considered.

So what should you do if you’re an older adult newly diagnosed with cancer? First, put together a team of healthcare professionals you trust. Make sure you know each team member’s role in your care.

Ask your doctor if he or she is experi­enced in caring for older adults with cancer and if you would benefit from a geriatric assessment, which would eval­uate your level of functioning, nutritional status, and available social support. This assessment can detect problems related to aging that cancer specialists may overlook but that can be addressed to make your cancer treatment more easily tolerable.

Bring a friend or family member along to your appointments to keep you company, take notes, and support you. It’s hard to remember everything said to you during a clinic visit, and although many doctors provide treatment summa­ries, it is very helpful to have someone there to take notes and serve as a second pair of ears.

You may want to ask your doctor if you’re eligible to participate in a clinical trial. Clinical trials usually represent the cutting edge of cancer care; however, doctors are less likely to offer them to older adults, even if they’re eligible to participate. That’s why you should always ask. In the majority of clinical trials with senior adult participants, the older population has benefitted from the exciting new treatments just as much as the younger individuals have.

Make sure you and your family are on the same page concerning your wishes. Sometimes family members want you to take a more aggressive treatment route than you do; sometimes it’s the other way around. You should discuss your goals and wishes with your friends and family, but ultimately, you’re the one who should make the final decisions regarding your care.

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Dr. Hyman B. Muss is professor of medicine at the University of North Carolina at Chapel Hill School of Medicine and director of geriatric oncology at UNC’s Lineberger Comprehensive Cancer Center in Chapel Hill, NC.

This article was published in Coping® with Cancer magazine, May/June 2015.