Senior Adult Oncology

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Senior Adult Oncology
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Overview

• Cancer is the leading cause of death for those
  60-79 years
• 60 of all cancers occur in patients who are 65
  years or older
• Older individuals are more prone to develop
  cancer due to physiological changes associated
  with aging

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Older Adults

• Older patients can be classified into three
  categories
• Young Old 65-75 years
• Old 76-85 years
• Oldest Old over 85 years

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Age Distribution of U.S. Population, 1980, 1990,
and 2005
Year 1980
Year 1990
Year 2005
85 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-
49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0
-4


Data source The Bureau of the Census
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Frailty

• Decreased reserve and resistance to stressors
• Frail patients have an increased risk of
  complications from cancer treatments
• Risk for falling, disability, hospitalization,
  and death

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Fraility Criteria

• Unintentional weight loss (10 lbs or more in past
  year)
• Self reported exhaustion
• Weakness
• Slow walking speed
• Low physical activity

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Geriatric Syndromes

• Malnutrition
• Polypharmacy
• Lack of Social Support

• Depression
• Dementia
• Fall Risk

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Falls

• One of the most common geriatric syndromes
• 30-40 of adults older than 65 years fall each
  year
• Risk factors muscle weakness and impairments in
  gait, vision, cognition, and ADLs

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Activities of Daily Living (ADLs)

• Able to bathe self
• Able to dress self
• Able to toilet self
• Control over bowel bladder
• Able to transfer self
• Able to feed self

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Instrumental Activities of Daily Living (IADLs)

• Use the telephone
• Get to places beyond walking distance
• Grocery shop
• Prepare meals
• Housework
• Laundry
• Take medications
• Manage money

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Percent of Medicare Beneficiaries Reporting
Difficulty with IADLs or ADLs by Age, 2004
Percent ()
Data Source Medicare Current Beneficiary Survey
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Percent of Persons Age 65 and Over (age-adjusted)
Reporting Selected Chronic Conditions by Sex,
2004-2005
Percent ()
Data Source National Health Interview Survey
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Years of Education Among Persons Age 65 and Over
(age-adjusted) by Sex and Race/Ethnicity, 2006
Female
Male
Percent ()
Data source Current Population Survey
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Cancer Treatment

• Benefits
• Prolonged survival
• Maintenance and improvement of quality of life
  and function
• Palliation of symptoms

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Cancer Treatments

• Risks
• Complications of surgery, radiation, and/or
  chemotherapy
• Affects on cognition, function, balance, vision,
  hearing, continence, and mood

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Treatment Decisions

• Life Expectancy
• Aggressiveness of Disease
• Functional Abilities
• Comorbidities
• Patient Goals
• Social Resources
• Tolerance of Treatment

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Treatment Decisions

• Advanced age alone should not preclude the use of
  effective cancer treatment
• Older patients with good performance status are
  able to tolerate most forms of treatments
• Treatment that diminishes quality of life with no
  significant survival benefit should be avoided