People are living longer and cancer treatments are becoming more effective as therapies become more targeted and personalized. Oncologists are expecting a dramatic increase in the number of older people with cancer in the next 20 years – and preparing to treat this population is a priority.
"As people get older, their risk of cancer increases, but other medical issues also become more complex," said Kathryn Bylow, MD, a geriatric oncologist with the Froedtert & the Medical College of Wisconsin Cancer Network. "There are many factors to consider as we personalize cancer care plans for older patients."
Treating an aging population
From 2010 to 2030, the American Society of Clinical Oncology expects the total projected cancer incidence to increase by 45 percent, from 1.6 million to 2.3 million, and 70 percent of all cancer diagnoses will be in people over the age of 65.1
"We call this the 'silver tsunami,'" Dr. Bylow said. "As the baby boomer population comes of age, there is going to be a massive wave of people who need cancer treatment. We need more randomized clinical trials that establish the safety and efficacy of treatments for older people with cancer so we can establish evidence-based guidelines for the geriatric population."
Historically, only a small percentage of patients in cancer clinical trials have been older. Most are younger and require less complex care because they have fewer additional diseases or disorders, known as comorbidities.
Staging the age of the patient, not just the cancer
Just as oncologists stage the cancer to determine the appropriate treatment, geriatric oncologists say it is equally important to "stage the age" of the patient. This is accomplished through a comprehensive geriatric assessment. A person's chronological age may not be the same as their functional age based on vulnerabilities, such as comorbidities and disabilities. If there are no vulnerabilities, providers may treat the older patient as they would a younger patient.
A comprehensive geriatric assessment can inform treatment decisions
The Froedtert & MCW Cancer Network uses geriatric assessments to identify potential risks or needs in older patients and inform cancer treatment decisions. The assessment includes validated tests designed specifically for older people and a standardized questionnaire.
"The comprehensive geriatric assessment addresses a number of important factors such as other medical issues, medications, physical function, mental health, social support and nutrition," Dr. Bylow said. "While these may seem like simple factors, they can affect a cancer patient's outcome. By doing a comprehensive assessment, we can identify areas of vulnerability and share that information with the treatment team."
The Froedtert & MCW comprehensive geriatric assessment evaluates:
- Physical health (other health problems, besides cancer, a person may have)
- Function (the ability to perform various tasks of daily living such as bathing and dressing)
- 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, the geriatric oncologist also meets with a patient's family to gain a better understanding of the patient's social support system.
Research has shown that geriatric assessments are a successful tool to improve communication about age-related concerns between an older patient and their oncologist.2 Researchers are very interested in the effect of geriatric assessments on the quality of life of older cancer patients. Studies are underway to determine how the results of geriatric assessments improve outcomes, including a randomized clinical trial investigating whether or not geriatric assessments can reduce chemotherapy side effects in older patients who have advanced cancer.
"We add meaningful data that helps cancer physicians make better treatment decisions so patients can benefit," Dr. Bylow said. "There is increasing evidence that by taking this proactive approach, older patients ultimately live longer and do better."