Not all cancer patients are created equal. Those who’ve entered retirement age — and kept right on going — need special care when diagnosed with cancer.
So says Arti Hurria, M.D., director of City of Hope’s Cancer and Aging Research Program. Hurria and a growing number of her fellow doctors are carefully looking at the challenges faced by older patients, so they can refine the best ways to treat them and maintain their quality of life.
“This is an incredibly exciting field right now because we have the opportunity to make strides in cancer care for the growing aging population,” said Hurria, one of a small number of physicians trained not only in medical oncology but also in geriatric medicine. That means she knows how to fight cancer, while also understanding the physical limitations and concerns that older patients face in their daily lives.
Statistics show that this knowledge is far from trivial. Even though the rates of deaths from cancer have declined and rates of new cancers have flattened, experts expect cancer to become a huge health issue in the coming decades. The overall growth and aging of the United States population means the number of patients age 65 and older is expected to double by 2030.
With this in mind, City of Hope oncologists recently brought together leading researchers from across the country for a summit on cancer and aging — the first meeting of oncologists from leading institutions who are working together to address cancer care in the nation’s growing senior population.
“Results of our research will apply to the majority of patients with cancer, because about 60 percent of cancer diagnoses and 70 percent of cancer deaths occur in patients older than 65,” Hurria said.
First of all, Hurria said, health professionals must better understand exactly how therapies affect older patients. “Unfortunately, patients 65 and older have been underrepresented in national cancer clinical trials, which set the standard for oncology care,” she said. That means that conclusions drawn about drugs mainly tested in younger patients might not apply precisely to older patients.
And older patients may experience declines in function related to their age that can affect what a physician should recommend for therapy. They may have problems in organs such as the kidney that might make certain drugs more toxic, for example. Physicians also must consider how the drugs they prescribe influence older patients’ ability to perform daily activities — simple but important actions ranging from getting up from a chair to going out to buy groceries.
Hurria also notes that older patients often take a variety of drugs for other conditions, such as high blood pressure or heart problems, and those drugs must be balanced with cancer medications.
Hurria and her colleagues are already working on a variety of studies in the field. For one, they are studying women who take certain important breast cancer-preventing drugs called aromatase inhibitors to understand whether these drugs affect memory and thinking. They also are working with pharmacists to understand how older patients’ bodies break down important cancer drugs.
At the same time, they are collaborating with other researchers to investigate survivorship in older patients and the important role that family members play in the care of older patients.
“This is really about understanding the needs of our patients,” Hurria said. “We need to understand all aspects of their lives, so that we can provide them with the treatments that provide the best chance at survival and the best quality of life.”
Older people may face tough challenges when dealing with cancer. These strategies from the American Society of Clinical Oncology, or ASCO, can help.
Enlist a family member or friend to help sort out information from your doctor. This friend can take notes or think of additional questions.
Develop a good relationship and open communication with your health-care team.
Organize your care. Keep records and written notes rather than relying on memory. A diary can help.
Plan transportation in advance. If family members cannot drive, health-care professionals may recommend ways to find alternate transportation.
Update legal medical documents. Be prepared and make sure to designate someone to carry out important medical decisions for you if you can’t make them yourself.
City of Hope's Department of Clinical Social Work can help Medical Center patients with a variety of issues surrounding cancer diagnosis and can suggest resources to meet older patients' needs.
More tips about aging and cancer are available from People Living With Cancer, or www.plwc.org, an ASCO Web site. PLWC offers a free booklet, “Cancer in Older Adults,” for download from the age-specific area of its site.