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Elderly And Aging Cancer Patients
Ernest H. Rosenbaum, MD, William Goodson, IV, BA
- Thlere is about an 11 times increased risk of developing cancer in persons over age 65 and a 15 times increased risk of dying from cancer. Two-thirds of all cancer patients are over 65. By 2030, the population over 65 will reach 70 million, which will cause a marked increase in the number of persons with cancer.
- The majority of the elderly and aging cancer patients are the largest recipients of chemotherapy.
The largest segment of the USA population is becoming 65 years or older with a life expectation of another 15 years and should will remain functionally independent during this time. A 75-85 year old has an average life expectancy of 10 and 6 years, respectively. About 65% of new cancers diagnosed occur in the elderly --over age 65.
Older patients with cancer often require functional assistance. The need increases as cancer survivors age. Thlere is about an 11 times increased risk of developing cancer in persons over age 65 and a 15 times increased risk of dying from cancer. Two-thirds of all cancer patients are over 65. By 2030, the population over 65 will reach 70 million, which will cause a marked increase in the number of persons with cancer.
- Performance Status is of help in the assessment The use of the Karnofsky or ECOG (Eastern Cooperative Oncology Group) for functional grading.
- An assessment of the activities of daily living and the aids necessary to improve self-care are important. Use of exercise rehabilitation physical therapy programs can help improve function.
There is often need for assistance at home or the need for institutional care. Treatment toxicity and recovery time are also important factors in the functional status.
Current and projected comorbid conditions play a major role in geriatric care. Control of hypertension, diabetes, heart and lung disease are vital components of both psychological and functional status. With age and with cancer patients, any deficit can make a major difference in daily living. For example, it is known that diabetes decreases the eight-year disease-free survival of stage three colon cancer equal to the beneficial effects of adjuvant chemotherapy.
Hyperinsulinemia decreases the survival in prostate, colon and breast cancer patients. Obesity projects a worse prognosis for ovarian and other cancers.
Thus, comorbidity affects survival, as well as functional life.
- There is a need for special assessment for geriatric oncology patients. It should include:
- 1. Whether the patients needs assistance with activities of daily living (ADLs).
2. Whether there is a need for increased home care use or nursing home placement due to dependency and frailty.
3. A general assessment that asks the following questions:
- Can you get out of a chair without assistance, walk ten feet, return and sit down?
- Are you able to dress yourself?
- Are you able to cook and prepare your meals?
- Are you able to shop independently?
- Are you able to get out of bed without assistance?
-Are you able to go to the bathroom without assistance?
-Are you able to bathe without assistance?
4. List of comorbidities and their treatments - heart disease, hypertension, arthritis, osteoporosis, obesity, gastrointestinal problems and diabetes.
5. Weight loss -- if greater than 10% of the body weight is lost, this could indicate poor nutrition along with decreased exercise and mobility (compare weight now to six months ago and one year ago).
6. Cognitive problems - decreased cognitive function or Alzheimer's disease predicts a decrease in survival rate. Patients must be evaluated to ascertain if they correctly can take their medications on an appropriate schedule, appreciate toxicities, or if they need help in preparing and taking medications? Older patients take about three times the number of medications as younger patients. This opens up the potential for medication errors, which are not uncommon. 30 percent of outpatients have a history of adverse drug reactions, often requiring hospitalization.
7. Psychosocial problems with difficulties in coping with daily needs, as well as support from family members, friends and caregivers.
8. Preparation for potential home emergencies with a plan, -- such as having the phone numbers of the physicians in an accessible location or having friends and family learn CPR and first aid.
9. Assessment for anxiety, depression and the need for psychosocial support.
- Knowing a patient's frailty, debility, cognition, ability to follow instructions and do self-care are areas requiring careful assessment and providing aid to help maintain both function and control of life.1
- Hybels CF, Pieper CF, Blazer DG, Fillenbaum GG, Steffens DC, Trajectories of mobility and IADL function in older patients diagnosed with major depression.Int J Geriatr Psychiatry. 2009 Jun 22.
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