The disease may be the same, but the body’s reaction to cancer and related treatment can be very different in older people. So, too, are the decisions about seeking care.
“As we age, we might want different things for our lives and value quality time more,” said Dr. Rawad Elias, a geriatric oncologist with the Hartford HealthCare Cancer Institute Cancer and Aging team.
Discussion of personal values and a geriatric assessment — now recommended by the American Society of Clinical Oncology for people over age 65 — are how the Cancer and Aging Program team tailors care to the physical and emotional needs of older patients.
“Although more than 60 percent of cancer in the United States is in older adults, the guidelines oncologists follow have been largely based on the experiences of younger people,” Dr. Elias said. “Often, treatment like chemotherapy has been dismissed for older adults as too harsh, or the opposite happens when an older person undergoes rounds and rounds of treatment and their quality of life is severely affected.
“By assessing each patient closely, we can give them care most appropriate for their age and condition and, most importantly, treatment that is tailored to their goals of care.”
Oncologists refer patients to the Cancer and Aging Program for the geriatric assessments, which include:
- Cognitive tests requiring patients to repeat word lists or count backward.
- Physical exam, including challenges such as walking test.
- Psychological exam and discussion of social activities and hobbies.
Based on the results, the Cancer and Aging team makes suggestions for treatment and supportive services. A patient with balance issues, for example, might get physical therapy before chemotherapy, which could worsen the condition.
The Cancer and Aging team includes:
- Dr. Elias, who is board certified in geriatrics and hematology/oncology and works with nurses, nurse practitioners and physician assistants conducting patient assessments and making recommendations.
- A geriatrician to follow some patients based on assessment results to help them maintain quality of life throughout treatment.
- A nutritionist to help patients maintain their strength during treatment and get the vitamins and minerals needed to help the body recover.
- Physical and occupational therapists to help patients maintain their independence, movement and function during treatment.
- A pharmacist who works on medication management, safe use and managing side effects from cancer treatment.
- Social workers for psychosocial counseling in individual or family sessions as older patients are at a higher risk of depression, anxiety and social isolation during illness.
- Palliative and integrative care therapies, which help relieve the pain, nausea and anxiety of cancer and cancer treatment.
- Hartford HealthCare Center for Healthy Aging, which provides assessments and information about help in the home.
“We tailor this network of care to the needs of each patient so they have the needed physical and emotional support to battle cancer,” Dr. Elias said. “It might be as simple as rallying family and friends so a patient has nutritious meals while going through treatment. Or it might be connecting them to a community service for rides to appointments.
“We know patients who are well supported during cancer treatment and who receive care tailored to them and their preferences do better overall. That is our ultimate goal.”
This work, he noted, is crucial given the statistics about cancer and the elderly. A 2017 study published in the Journal of Clinical Oncology indicates that the rate of cancer in the elderly will rise 67 percent between 2010 and 2030.
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