Senior Adult OncologySenior Adult Oncology

OverviewOverview

Cancer is the leading cause of death Cancer is the leading cause of death for those 60-79 yearsfor those 60-79 years

60% of all cancers occur in patients 60% of all cancers occur in patients who are 65 years or olderwho are 65 years or older

Older individuals are more prone to Older individuals are more prone to develop cancer due to physiological develop cancer due to physiological changes associated with agingchanges associated with aging

Older AdultsOlder Adults

Older patients can be classified into three Older patients can be classified into three categories:categories:

Young Old: 65-75 yearsYoung Old: 65-75 years Old: 76-85 yearsOld: 76-85 years Oldest Old: over 85 yearsOldest Old: over 85 years

Age Distribution of U.S. Population, 1980, Age Distribution of U.S. Population, 1980, 1990, and 20051990, and 2005

Data source: The Bureau of the Census

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

FrailtyFrailtyDecreased reserve and resistance to Decreased reserve and resistance to

stressorsstressors

Frail patients have an increased risk of Frail patients have an increased risk of complications from cancer treatmentscomplications from cancer treatments

Risk for falling, disability, hospitalization, and Risk for falling, disability, hospitalization, and deathdeath

Fraility CriteriaFraility Criteria

Unintentional weight loss (10 lbs or more in past year)Unintentional weight loss (10 lbs or more in past year)

Self reported exhaustionSelf reported exhaustion

WeaknessWeakness

Slow walking speedSlow walking speed

Low physical activityLow physical activity

Geriatric SyndromesGeriatric Syndromes

MalnutritionMalnutrition

PolypharmacyPolypharmacy

Lack of Social Lack of Social SupportSupport

DepressionDepression

DementiaDementia

Fall RiskFall Risk

FallsFalls

One of the most common geriatric One of the most common geriatric syndromessyndromes

30-40% of adults older than 65 years fall 30-40% of adults older than 65 years fall each yeareach year

Risk factors: muscle weakness and Risk factors: muscle weakness and impairments in gait, vision, cognition, and impairments in gait, vision, cognition, and ADLsADLs

Activities of Daily Living (ADLs)Activities of Daily Living (ADLs)

Able to bathe selfAble to bathe self Able to dress selfAble to dress self Able to toilet selfAble to toilet self Control over bowel & bladderControl over bowel & bladder Able to transfer selfAble to transfer self Able to feed selfAble to feed self

Instrumental Activities of Daily Instrumental Activities of Daily Living (IADLs)Living (IADLs)

Use the telephoneUse the telephone Get to places beyond walking distanceGet to places beyond walking distance Grocery shopGrocery shop Prepare mealsPrepare meals HouseworkHousework LaundryLaundry Take medicationsTake medications Manage moneyManage money

Percent of Medicare Beneficiaries Reporting Difficulty with Percent of Medicare Beneficiaries Reporting Difficulty with IADLs or ADLs by Age, 2004IADLs or ADLs by Age, 2004

Data Source: Medicare Current Beneficiary Survey

Per

cent

(%

)

0

5

10

15

20

25

30

35

65-74 75-84 85 years and over

IADL Only 1 to 2 ADLs 3 to 6 ADLs

Percent of Persons Age 65 and Over (age-adjusted) Percent of Persons Age 65 and Over (age-adjusted) Reporting Selected Chronic Conditions by Sex, 2004-2005Reporting Selected Chronic Conditions by Sex, 2004-2005

0

10

20

30

40

50

60

Hypertension Arthritis Heart disease Cancer Diabetes

Male Female

Data Source: National Health Interview Survey

Per

cent

(%

)

Years of Education Among Persons Age 65 and Over Years of Education Among Persons Age 65 and Over (age-adjusted) by Sex and Race/Ethnicity, 2006(age-adjusted) by Sex and Race/Ethnicity, 2006

0

10

20

30

40

50

60

70

Less than HighSchool

High School More than HighSchool

Less than HighSchool

High School More than HighSchool

White non-Hispanic Black non-Hispanic HispanicData source: Current Population Survey

Per

cent

(%

)

Male Female

Cancer TreatmentCancer Treatment

Benefits:Benefits: Prolonged survivalProlonged survival

Maintenance and improvement of quality Maintenance and improvement of quality of life and functionof life and function

Palliation of symptomsPalliation of symptoms

Cancer TreatmentsCancer Treatments

Risks:Risks: Complications of surgery, radiation, and/or Complications of surgery, radiation, and/or

chemotherapychemotherapy

Affects on cognition, function, balance, Affects on cognition, function, balance, vision, hearing, continence, and moodvision, hearing, continence, and mood

Treatment DecisionsTreatment Decisions

Life ExpectancyLife Expectancy Aggressiveness of DiseaseAggressiveness of Disease Functional AbilitiesFunctional Abilities ComorbiditiesComorbidities Patient GoalsPatient Goals Social ResourcesSocial Resources Tolerance of TreatmentTolerance of Treatment

Treatment DecisionsTreatment Decisions

Advanced age alone should not preclude the Advanced age alone should not preclude the use of effective cancer treatmentuse of effective cancer treatment

Older patients with good performance status are Older patients with good performance status are able to tolerate most forms of treatmentsable to tolerate most forms of treatments

Treatment that diminishes quality of life with no Treatment that diminishes quality of life with no significant survival benefit should be avoidedsignificant survival benefit should be avoided