The Baby Boom will soon turn into the Elder Boom — and that has geriatric oncologists such as Arti Hurria, M.D., concerned.

Researchers call for more specific care focused on the needs of older patients. (Photo by Walter Urie)

The U.S. population aged 65 years and older is expected to double between 2000 and 2030. About 60 percent of all cancers and 70 percent of cancer deaths occur in people in this age group, yet the medical world lacks specific information about how best to care for cancer patients in their 70s and beyond.

Hurria, director of City of Hope’s Cancer and Aging Research Program, and a small but growing number of physicians are calling for a new vision of treatment for these older patients: one that uses a specific assessment tool to understand each person’s specific needs.

Writing in last December’s issue of the Journal of the American Geriatrics Society, Hurria issued a call for the development and use of a geriatric assessment tool in oncology. This tool would illuminate the unique needs and challenges of older patients so that physicians and other providers could give the best care possible.

“Not all 75-year-old patients are the same,” explained Hurria. “One might be a ‘young 75,’ an active person with few other health problems — while another might be what oncologists describe as an ‘old 75,’ someone with other serious health conditions who has difficulty functioning on their own.

“As oncologists, we’re increasingly finding that these two patients may do best with different treatment. But we need a standard assessment tool to determine this functional age, so we can respond accordingly.”

Hurria and other geriatric oncologists have been working on assessment models for several years. A geriatric assessment would include these factors:

• Functional status — someone’s need for help in activities of daily living. Research has shown that older adult cancer patients with poor functional status may have greater risk of complications or, in some cases, death.
• Other medical conditions — diabetes, heart problems or other medical challenges common in the elderly. Heart disease might steer physicians away from prescribing chemotherapy regimens using anthracyclines, for example, because of risk of heart failure.
• Nutrition — how well patients are able to eat. Research has shown that a home-based diet and exercise program can actually help improve patients’ nutritional well-being.
• Cognitive function — the ability to think, reason, learn and remember. Cognitive problems are more common in the elderly, and they may affect how well a patient can follow complicated instructions when taking medications.
• Social support and psychological state — patients’ social network and emotional well-being. Studies have shown that older patients who are isolated have a poorer prognosis.

Arti Hurria (Photo by p.cunningham)

“Oncologists need a time-efficient, cost-effective method to identify older adults who are most vulnerable to side effects of drugs and who need more evaluation or interventions to make the most of their cancer therapy,” Hurria said.

She noted that the National Comprehensive Cancer Network Senior Adult Oncology Task Force has outlined recommendations for older adults with cancer — a starting point for integrating these assessments into daily practice.

“We still have a lot of questions to answer,” Hurria said. “But we are pushing for this research, and we’re going to make it happen. Our growing population of older adults with cancer needs improved, evidence-based care.”