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Comorbid Issues in Geriatric Oncology
Ernest H. Rosenbaum, MD
Memory and Cognition Status
Psychological Status and Support
Maintenance Drug Therapy
As people with cancer age, between 25-50% have some cognitive abnormalities, which may affect their oncologic care. Cognitive dysfunction can alter decisions on cancer therapy and treatment plans. Also, cancer therapy, be it chemotherapy, radiation or surgery, can affect cognitive function.
Several studies have shown that weight loss is an important prognostic factor for survival in cancer patients. Even a 5% weight loss can have significance. It was also noted that a poor nutritional status correlated with depression.
Overweight is also a major problem, leading to several comorbid conditions. In one study, 71% of geriatric cancer patients had a BMI greater than 25 and had improvement on a weight-loss diet.
In the Nurses' Health Study, socially isolated women had a 66% increased risk of all-cause mortality and a two-fold increased risk of breast cancer-specific mortality. Much of this was related to lack of assess to care from family and friends. Social isolation is a major problem for older adults in general and is a risk factor for psychological distress. Depression is a major problem. Psychosocial and family support is important, as depression does affect the outcome of older patients.
In a study of ovarian cancer patients treated with platinum-based chemotherapy, depression was the strongest prognostic factor for survival.
It is often important to take multiple drugs, and there is great confusion and frequent errors in how drugs are taken. The inclusion of a pharmacist consultation and aid is very helpful in reducing the risks of poly-pharmacy, as well as being more cost-effective.
Support through nursing services, telephone calls and medical team support is very helpful in aiding older cancer patients live as normal a life as possible. There are a variety of ways and interventions that can be used. Screening for physical and psychosocial problems is part of the assessment process. This can be done most often by a geriatric specialty nurse. In conclusion, a comprehensive geriatric assessment is vital to the care and quality of life of aging cancer patients. Through good supportive techniques, quality of life can be improved. New strategies are currently being developed.
Reference: Extermann, M. and Hurria, A., "Comprehensive Geriatric Assessment for Older Patients with Cancer", J Clin Oncol, 25: 1824-1831, 2007
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