Cancer In The Elderly: Adopting A Holistic Approach

With improved standards of living and greater access to healthcare, today, people are living longer than ever before. The incidence of cancer rises steadily with age ,to peak at about 65 to 75 years. The burgeoning number of elderly cancer patients, have lead to development of the field of Geriatric Oncology as a comprehensive model of cancer care for the elderly.

What are the challenges in treating elderly cancer patients

The care of elderly cancer patients is often complicated by multitude of comorbidities, poor physical reserve, dementia and poor social support. Today, it is a common sight to see elderly couple struggling to support each other, both in fighting away loneliness and during the demanding times of hospitalisation. Moreover, as symptoms of cancer often overlap with those of ageing, diagnosis of the disease is usually made late. From an oncology perspective, the optimal treatment for these patients are also not well defined as they are often omitted from large clinical trials.

Approach to the elderly cancer patient - Involves multidisciplinary team with focus on

1. Incorporation of Geriatric Assessment into preclinical assessment - This involves systematic recording of patient’s ability to carry out activities of daily living, self care, vital parameters, nutritional status, cognition, urinary and bowel continence etc at the first visit and at regular intervals thereafter. Systematic Geriatric Assessment often reveal key constraints, which would have otherwise been overlooked.
2. Due weightage is given to patients’s comorbidities - Well validated tools are available today, to predict the anticipated toxicity from chemotherapy based on the comorbidities and organ function status. These scores are taken into account while deciding on the treatment.
3. Patient centric approach - Therapy is tailored according to the preferences and expectations of patient and the caregivers. The functional age rather than the chronological age is taken into account.

Selecting therapy

The ideal systemic treatment for an elderly cancer patient would be a drug which will be easy to administer and efficacious but at the same time devoid of major adverse effects like vomiting, hairfall, count drop, infections etc. As technology advances, cancer treatment is moving away from chemotherapy, towards targeted therapy and immunotherapy, which are more specific in action and manageable in the toxicity profile.

1. Chemotherapy : Cancers inherently sensitive to chemotherapy may be treated with chemo, either as single agents or as combination. The general health of the patient should be reasonably good if chemotherapy is being considered.
2. Targeted therapy : banks on the principle that cancer cells thrive on definite growth signals and blocking these signal pathways would apply breaks to tumor growth. Most of the targeted agents are available as oral tablets, relatively spares the normal tissues and are approved for use in patients with poor performance status.
3. Immunotherapy : The sensible idea of augmenting our body’s immune system and empowering it to fight the tumor is put to use in this promising treatment approach. Monoclonal antibodies are available only as infusions, but are surprisingly well tolerated by the elderly and the infirm.
4. Metronomic chemotherapy : is the repeated administration of chemotherapy drugs at relatively low doses and without drug free interval. Predominantly by inhibiting tumor blood vessel formation, this approach has been shown to work well in controlling tumor growth.

Treatment of elderly cancer patients is a tight rope walk, a balancing act between expectations and reality.