Improving Cancer Care for Geriatric Patients

In medicine, as in other professions, we have become accustomed to the refrain that we live in “an aging society.” The massive demographic shift in age occurring in the U.S. and other countries worldwide is beginning to affect healthcare delivery and specialization in countless ways. Oncologists are seeing the impact of this shift in the age of the patients they treat and their specific medical and psychosocial needs. Geriatric oncology, a specialty that has experienced chronic workforce shortages for some time, is now in growing demand as treatments for cancers become more complex, comorbidities multiply, and healthcare costs climb. In a 2018 ACCC survey of its membership, only 32 percent of respondents said they have received geriatric oncology training. To support the multidisciplinary team in understanding and proactively preparing for the impact of our graying nation on cancer prevalence and co-morbidity burden, ACCC launched an education program that explores Multidisciplinary Approaches to Caring for Geriatric Patients with Cancer. Last week, the first installment of a six-part webinar series for this program was aired. On April 8, Efrat Dotan, MD, MTR, associate professor in the Department of Medical Oncology at Fox Chase Cancer Center in Philadelphia, presented on overview of the challenges in managing older adults with cancer, starting with the limited data currently available to guide oncologists on the specialized needs of these patients.

Dr. Dotan told webinar attendees that the American Medical Association characterizes patients age 65 and older as “The group of patients that presents the most complex and challenging problems to the physician and all healthcare professionals.”¹ This patient group, said Dr. Dotan, which is already on the rise, is projected to skyrocket in the near future.

Today, the fastest growing segment of the U.S. population is people age 75 and older. The number of Americans age 65 and older will more than double from 46 million today to more than 98 million by 2060.

The implications for oncology are clear. As people age, their likelihood of developing cancer increases. Simply put: an older population means a higher incidence of cancer. By 2030, it is estimated that 70 percent of cancers will be diagnosed in older adults.² And geriatric patients do not necessarily respond to the treatment protocols most often used for younger patients. Delivering optimal care to this patient segment requires specialized knowledge of how cancer affects older bodies, assessment of multiple functional domains, and a specific set of tools with which to determine the best treatment options.

Although we currently are not adequately equipped to deal with the projected surge in older patients, there are tools that oncology clinicians can put into practice today to help them better assess their older adult patients. Dr. Dotan called attention to the vital role that comprehensive geriatric assessments (CGAs) can play in patient care and shared decision-making. Consider the many clinical pathways that affect older adult patients. A CGA evaluates all of these, and the results can be used to inform treatment decision-making. There are a number of validated tools available to help clinicians evaluate their older patients’ fitness for treatment and the suitability of different therapy options.

For example, comprehensive geriatric assessments (CGAs) can gauge such patient variables as functional status, nutritional status, cognitive impairment, and comorbidities, which can help clinicians predict factors such as chemotherapy toxicity and the suitability of different therapies. Under the ACCC Multidisciplinary Approaches to Caring for Geriatric Patients with Cancer web section, you will find curated resources including screening tools, cognitive status tests, functional status assessments, polypharmacy assessments, and psychosocial distress screenings.

One simple step toward improving care for your older adult patients with cancer: View the ACCC webinar series on multidisciplinary approaches to caring for geriatric cancer patients, covering topics ranging from polypharmacy considerations to palliative care. You can register for the webinars that interest you here. All webinars are free. The next webinar in the series— What Every Cancer Program Team Member Needs to Know About Geriatric Assessment—is on Monday, April 22.
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1. American Medical Association White Paper on Elderly Health. Report of the Council on Scientific Affairs. Arch Intern Med. 1990: 150:2459

1. Smith BD, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758-2765.