Geriatric Oncology - Cancer Risk Increases With Age

Cancer is a disease of aging. While anyone can develop cancer, the risk of getting the disease increases with age. Certain cancers, in particular, are linked to aging, such as breast, colorectal, prostate, pancreatic, lung, bladder and stomach cancers. 

Cancer and Aging

For many reasons, older adults (generally age 70 and higher) with cancer have different needs than younger adults with the disease. Treatment for older adults needs to consider many issues. For example, older adults:

• May be less able to tolerate certain cancer treatments.
• Have a decreased reserve (the capacity to respond to disease and treatment).
• May have other medical problems in addition to cancer.
• May have functional problems, such as the ability to do basic activities (dressing, bathing, eating) or more advanced activities (such as using transportation, going shopping or handling finances).
• May not always have access to transportation, social support or financial resources.

The single most important risk factor for cancer is age. Due to the increase in life expectancy, cancer in older people is becoming increasingly common. According to the American Cancer Society, 77 percent of all cancers are diagnosed in persons age 55 and older.

Geriatric Oncology Specialist

Because older adults with cancer have special needs, they require expert care. Few physicians have the knowledge in both cancer treatment and the best care for older adults. Medical College of Wisconsin geriatric oncologist Kathryn A. Bylow, MD, is dedicated to caring for older adults with cancer. Dr. Bylow has special training in:

• Geriatrics — the area of medicine that focuses on disease and disability in later life
• Oncology — the area of medicine concerned with cancer prevention, diagnosis and treatment

Dr. Bylow is one of a small number of geriatric oncologists in the United States and the only one in southeastern Wisconsin. She is board-certified in medical oncology, internal medicine and geriatric medicine. In particular, Dr. Bylow specializes in cancers of the:

• Gastrointestinal tract — anal, colorectal, small intestine, liver, pancreatic, stomach and gallbladder cancers
• Genitourinary tract — bladder, penile, prostate, kidney, ureter and urethral cancers

Dr. Bylow is also actively involved in research on cancer in older patients. In 2006, she received the American Society of Clinical Oncology Young Investigators Award for her work studying frailty and movement disorders in older men with prostate cancer.

Comprehensive Geriatric Assessment

To determine the most appropriate treatment for a patient, Dr. Bylow conducts a Comprehensive Geriatric Assessment (CGA), an in-depth evaluation of older patients. The CGA provides a detailed view of an older adult’s overall condition, focusing on functional status and quality of life. The assessment provides information to develop a care plan as well as interventions for other problems a patient may have.

The CGA evaluates factors where age-related changes are more likely, including:

• Physical health (other health problems a patient may have)
• Function (the ability to perform various tasks of daily living)
• Cognition (the ability to think, reason and perceive)
• Emotions (depression, for example, can affect treatment)
• Social environment (access to transportation, family caregivers, home safety, financial concerns, etc.)
• Nutrition (malnutrition can affect treatment)
• Medications (reviewing a patient’s medications to avoid interactions with cancer therapy and to determine which ones will be needed for future care)

During the assessment, Dr. Bylow also meets with a patient’s family to gain a better understanding of the patient’s social/support environment and other factors related to care.

Identifying Patients at Risk

The CGA can help to identify cancer patients who appear to be healthy but may be susceptible to a poor health outcome. When appropriate, interventions (care provided to improve a problem) can be used to better prepare them for cancer treatment. For example, the CGA may show a patient who is:

• Susceptible to falling and breaking a hip, which can lead to other health problems and greatly affect cancer treatment. For this patient, physical therapy may be prescribed to increase strength and reduce the risk of falling prior to cancer treatment.
• Not receiving enough nutrition, which can reduce the ability to tolerate certain types of cancer treatment. In this case, a dietitian will create an individual nutrition program for the patient prior to cancer treatment.

Individual Treatment Plans

Using the CGA and other information, Dr. Bylow creates an individual treatment plan, tailoring care to each patient. She works with other team members at Froedtert & the Medical College of Wisconsin, including nurses, physical therapists, dietitians, social workers and others to meet all of a patient’s needs.

Dr. Bylow emphasizes that advanced age alone should not prevent the use of effective cancer treatment that may improve quality of life or extend meaningful survival. Some older adults are able to tolerate aggressive treatment for cancer, while others are not because of other health concerns or problems. 

Using the CGA, Dr. Bylow identifies patients who are likely to receive the greatest benefit from treatment. The patient’s wishes for treatment and quality of life are integral to the treatment plan; Dr. Bylow discusses the patient’s goals, including whether the proposed treatment is desired.