by Gina Keiffer, MD, Andrew E. Chapman, DO, FACP, and Kristine Swartz, MD
No two seniors are the same. Each senior adult has an individual set of goals and values they bring with them to managing their cancer diagnosis. Some seniors over age 65 are fit, healthy, and relatively symptom-free, while others may have chronic illnesses that affect their daily lives. Therefore, it is important for senior adults and their healthcare providers to consider multiple factors – including individual goals, health status, medical problems, and chronic medications – when developing an individualized treatment plan to best meet their needs.
Setting Goals for Treatment
As a senior adult considering therapy for cancer, the most important question to ask yourself is “What is most important to me in my daily life going forward?” Some seniors may place a high priority on remaining free of symptoms and at home with their family. Others may prioritize the impact their health may play on their loved ones. For some seniors, staying free of symptoms is more important than “curing” their cancer. Still others may be willing to tolerate more intensive therapy if it has the potential of offering them more time with the people they care about. The answer to this question is different for everyone.
As a senior adult considering therapy for cancer, the most important question to ask yourself is “What is most important to me in my daily life going forward?”
As a senior adult, it is important to think about your individual goals for treatment as you approach developing a treatment plan with your providers. In his book Being Mortal, Dr. Atul Gawande suggests the following list of questions to ask when considering life-sustaining treatments:
- 1. What is your understanding of where you are and of your illness?
- 2. What are your fears or worries for the future?
- 3. What goals and priorities are most important to you?
- 4. What outcomes are unacceptable to you? What are you willing to sacrifice and not?
- 5. What does a good day look like?
Answering these questions for yourself before a visit with your oncologist can help you better express your priorities with your doctor.
A Multidisciplinary Approach to Shared Decision Making
Shared decision making refers to a process by which clinicians and survivors work together to make decisions and choose treatments that balance risk and expected outcomes with each individual’s goals and preferences. To do this most effectively, a multidisciplinary approach that helps define and then match treatment preferences to individual goals is recommended.
Because of the complexity of cancer care, there may be other specialists in addition to your oncologist who are involved in your care. In a senior adult oncology center, a geriatrician (a medical doctor that specializes in the care of older adults), a pharmacist, nutritionist, and a social worker may all be part of your cancer team. If you don’t have a specialized center such as this near you, your oncologist can arrange for you to see these specialists and can incorporate their expertise into your care. Each provider will meet with you individually to discuss your cancer diagnosis and any other medical problems you may have.
You will have time to ask specific questions and to discuss your goals for treatment, as well as your concerns. This will likely include asking questions about how a specific treatment may make you feel or the potential benefit it has to offer. It can also include asking about the potential impact of cancer treatment on your loved ones or about things you can do at home to help you stay fit and healthy. You should also have an opportunity to discuss the financial impact of cancer treatment and any issues you may have with insurance or transportation. It may be helpful to have a family member or close friend with you to help ask clarifying questions, jot down notes, and provide support.
The most important member of a multidisciplinary team is you. The goal of a multidisciplinary approach to shared decision making is to use the input of all members of the team – especially yours – to develop the best treatment plan for you. The best treatment plan is one that maximizes benefit and minimizes risk while taking into account your individual needs and goals.
Dr. Gina Keiffer (left) is a second-year fellow in sub-specialty training in Hematology and Medical Oncology at Thomas Jefferson University Hospital in Philadelphia, PA.
Dr. Andrew Chapman (right) is a clinical professor of Medical Oncology in the Department of Medical Oncology at the Sidney Kimmel Cancer Center at Jefferson and a clinical professor in Jefferson’s College of Nursing. He is also the chief of Cancer Services for the Sidney Kimmel Cancer Center, the Enterprise SVP of the Jefferson Health system for Medical Oncology, and vice chair of Clinical Operations for the Department of Medical Oncology. Additionally, Dr. Chapman is the cofounder and codirector of the Senior Adult Oncology Center at the Sidney Kimmel Cancer Center, which specializes in the multidisciplinary evaluation and management of seniors with cancer.
Dr. Kristine Swartz (left) is an assistant professor in the Department of Family and Community Medicine, part of the Division of Geriatrics and Palliative Care, at Jefferson. She also serves as codirector of the Senior Adult Oncology Center and maintains a primary care practice for older adults.
This article was published in Coping® with Cancer magazine, January/February 2019.