‘Staging’ key to treating older cancer patients

A new study suggests that older adults diagnosed with cancer—like 92-year-old Louis Falzer, who survived prostate cancer—are more likely to become frail and vulnerable. The findings could be helpful in developing a new staging approach to caring for older adults. (View this and other videos at Futurity’s YouTube channel:

U. ROCHESTER (US)—New findings suggest that when older adults are diagnosed with cancer, other health issues, along with the stage of cancer, should be considered by doctors when planning care.

“In our analysis, relative risk estimates show that a cancer diagnosis increases the probability of being more vulnerable or frail by 9 to 33 percent, compared to those without cancer,” says lead author Supriya Mohile, geriatric oncologist and assistant professor at the University of Rochester Medical Center.

The study, which appears in the July 28 issue of Journal of the National Cancer Institute, is the first step toward “staging the aging” when it comes to geriatric cancer patients, Mohile says.

To better understand the effect of a cancer diagnosis on vulnerability and frailty, the researchers analyzed the 2003 health records of 12,480 Medicare beneficiaries (age 65 or older), a nationally representative sample of the elderly population. About 19 percent reported a non-skin cancer diagnosis, most often colon, breast, or prostate cancer, ranging from recent diagnosis to long-term survivor.

The researchers found that when compared to the people who had never had cancer, the cancer group reported significantly higher rates of an inability to engage in certain life skills—including bathing, cooking, and light housework—higher rates of unrelated illnesses, and geriatric syndromes such as dementia, depression, incontinence, and falls.

Estimates are that 50 percent of all malignancies in the United States occur in people who are at least 65 years old. By 2030, projections indicate about 70 percent of cancer patients will be older.

Older doesn’t necessarily mean a lower quality of life, especially for those who are otherwise physically fit and independent, notes Mohile, who sees patients who are up to 100 years old and enjoying life.

One such patient, 92-year-old Louis Falzer, of Rochester, survived prostate cancer and is enjoying his longevity. His secret, he says, “is not crawling into a corner,” and instead focusing on eating right, staying active—he was a runner into his early 80s—and keeping a sharp mind with the help of part-time work, puzzles and books, and a close circle of friends.

Mohile says researchers hope to develop and validate tools that will help physicians and researchers assess underlying vulnerabilities, and to design clinical trials that focus on identifying ways to improve quality of life.

“It’s important to realize that older patients are a very heterogeneous group,” Mohile adds. “Future research should focus on identifying which cancer patients are at the highest risk for developing life-threatening impairments as they face cancer treatment.”

The study was funded by the Hartford Health Outcomes Research Scholars Award.

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