Cancer Care Comes of Age
by Deborah Boyle, RN, MSN, FAAN
Older people with cancer often have a different set of concerns than other adults with cancer. Cancer care needs to be specifically tailored to this ever-growing population.
Cancer is a disease of aging. Consider these facts:
⇒ Older adults (over age 65) represent 13 percent of all Americans, yet they are diagnosed with 60 percent of all cancers.
⇒ A person’s risk for developing cancer rises exponentially with increased age. Adults age 40 to 59 have an 8 to 9 percent risk, while adults over age 60 have a 20 to 30 percent chance of being diagnosed with a malignancy.
⇒ People over age 65 account for two-thirds to three-quarters of colon, pancreas, prostate, bladder, stomach, lung, and rectal cancers.
Despite the conspicuous nature of these findings, one may ask, why hasn’t this reality been made more prominent?
One answer may be ageism, the societal prejudice against growing old. Advancing years are frequently correlated with images of decline, dependence, depression, and death. Yet the elderly are a very diverse group. Not all older adults are frail and in need of around-the-clock care. Like the young, they should be considered in subsets and be assessed by their physiologic, rather than chronologic, age. Similar to the very young at the other edge of the aging spectrum, older adults have unique characteristics that may bring about vulnerability and, hence, warrant special considerations during cancer care.
The older adult with cancer is uniquely distinguished by the likelihood that he or she may have other chronic medical conditions, such as heart disease or diabetes, during the cancer experience. Identified by health professionals as comorbidities, these infirmities may influence the recognition of new or recurrent cancer and the appropriateness of cancer treatment selection. Comorbidities also increase the likelihood of polypharmacy – the routine use of multiple medications.
Currently, more than 60 percent of cancer survivors
are over age 65.
Also unique to the older adult’s experience with cancer is concern about the availability of adequate caregiver support. Adult children may not live in close proximity to assist with caregiving or they may be unable to help due to competing demands from their own immediate family. Older spouses may themselves be compromised by chronic illness and, thus, be limited in the scope of caregiving support they can provide. Transportation may be a problem for routine cancer therapies, and insurance may not cover costs of treatment. In addition, out-of-pocket expenses may be prohibitive for older families on fixed incomes.
Of special note is the number of cancer survivors who are elderly. Currently, more than 60 percent of cancer survivors are over age 65. With the projected graying of society in the coming decades, a doubling of cancer cases is envisioned, along with a parallel number of older survivors. This elder cohort will require improved ongoing surveillance, as along with age and cancer history comes the likelihood of long-term effects from cancer therapies, the prominence of second and third malignant primaries, and the possibility of cancer recurrence.
An enhanced future of cancer care requires recognition of older people with cancer being historically under-served. To counter this reality, a number of changes must be enacted. These include
- a heightened national emphasis on community education that delivers the message of increased risk for cancer with advancing age;
- changes in insurance coverage for cancer screening, treatment education, home care, and specialized nursing services for older Americans;
- funding of research endeavors that investigate model programs of social support and family caregiving;
- promotion of clinical trials targeting the elderly that investigate not only cancer therapies but also optimum symptom management approaches and interventions that restore functional ability (such as exercise, nutrition, and self-care);
- investigation of new technological aides that promote remote, home-based monitoring; and
- evaluations that identify older adults’ potential risks during cancer therapy.
As America continues to age, an increasing awareness of cancer being a disease of older adults will escalate. With this recognition will come a greater appreciation of the complexity of older adults with cancer and their need for a cohesive, highly specialized team of health professionals to manage their care. Envisioning a future where a specialty of geriatric oncology parallels pediatric oncology is the ideal, but much required, reality.
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Deborah Boyle has chaired multiple initiatives addressing cancer in the elderly for the Oncology Nursing Society. She has received numerous awards for her efforts advocating on behalf of older adults facing cancer.
This article was originally published in Coping® with Cancer magazine, November/December 2010.