One big topic up for discussion at the conference of the American Society of Clinical Oncology, which winds down today in Chicago, has been the aging of the American population and its impact on the cancer field.
At a session over the weekend, Arti Hurria, M.D., of the City of Hope, noted that the United States is experiencing a rapid increase in the senior population. The number of Americans 65 and older will double by 2030, with the largest growth among people 80 and up.
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Cancer is a disease associated with aging, and cancer cases are expected to increase 67 percent by 2030 from 2010 numbers.
Hurria chaired a session titled ”Challenges in Managing and Coordinating Care in Different Settings for Geriatric Patients with Cancer.” She and her fellow presenters, Miriam B. Rodin, M.D., of the Saint Louis University School of Medicine, and Heidi D. Klepin, M.D., of Wake Forest Baptist Health, stressed the need to evaluate patients better before making treatment decisions and that those evaluations should not be based primarily on the individual’s chronological age.
“Stop thinking about age and start thinking about other factors,” Hurria urged, noting that some oncologists dismiss certain treatment options, such as chemotherapy, simply because they feel the patient is too old to handle them. Rather, they should ask, what is the patient’s physical capacity, mindset, decision-making ability, family situation and so on? “Functional age” trumps however many years of life a patient has under his or her belt, Hurria said.
Rodin agreed, noting that a healthy 90-year-old is likely to live longer than a sick 80-year-old and a healthy 80-year-old will live longer than a sick 70-year-old.
“Loss of peak performance capacity is not the same as the loss of all performance capacity,” Rodin said. A 75-year-old runner who finishes a marathon may take longer than she used to, but she still finished it.
That reality underscores the need for integrating geriatrics and oncology and for conducting a geriatric assessment of the older patient before deciding on a treatment regimen. Will chemotherapy be too toxic for this individual? How much and how long should the treatment last? Is the patient able to maintain a healthy diet? Does he remember to take his medications?
Geriatric assessments can be straightforward and fairly easy to conduct as part of the patient visit. And templates have been developed to score the findings.
As in other areas of care, medication errors are often the result of poor transitions from one caregiver to another or from one care setting to another, the speakers said. Better communication and coordination are essential, particularly, perhaps, when it comes to patients discharged from the hospital to a nursing home.