More than half of patients diagnosed with cancer are older than 65. Some of them are in great shape, others are frail. A new tool is helping doctors successfully treat older cancer patients.
Under current standards, they are all treated the same way, which can have deadly consequences.
At 91-years-old, nothing slows Bill Owen down.
"I go out and work my garden, go out here and cut me some wood and stack it out here," he says.
He is an avid hunter, a World War II vet, a die-hard baseball fan, and now he has another title: cancer survivor.
"It about scared me to death," said Owen.
Doctors diagnosed him with stage four lymphoma four years ago. Because of his age, he and his wife were told to go home and enjoy what time he had left, said Barbara, his wife.
Doctor Heidi Klepin of Wake Forest Baptist Medical Center, says treatment decisions are difficult because most clinical trials only include younger patients.
"It's not clear exactly which older patients are going to benefit from any given therapy,” said Klepin.
Treatment recommendations are often based on age alone, but take a fit 80-year-old versus a frail one.
"If you applied the same treatment to both of those patients,” said Klepin. “You would either under-treat the fit 80-year-old patient or over treat and potentially harm the frail 80-year-old patient."
That is where a first of its kind assessment tool comes in. Doctor Klepin used it to evaluate seniors with leukemia. She measured everything from physical function to a patient's mental state. Her findings show those who scored poorly before chemo have a higher risk of death.
"People want to know what are the risks for me to go through this therapy? What are the benefits?” she said. “With this type of assessment, we can start answering those questions."
For Bill, it meant finding another doctor and undergoing chemo. He says that now, “I still go all day long,” never letting cancer hold him back.
Doctor Klepin hopes her study will help create a nationwide test for oncologists that can determine which seniors will benefit from aggressive treatment and which will not.
Then they will be able to individualize treatment plans.
She is also in the process of enrolling for a new study looking at whether factors like exercise can help improve outcomes for seniors who undergo cancer treatment.
BACKGROUND: In 1971, there were 3 million cancer survivors. In 2007, that number jumped to 11.7 million. Of the 11.7 million people living with cancer in 2007, about 7 million were 65 years of age or older. Most of the survivors (54 percent) are women, with breast cancer survivors making up the largest group (22 percent). Then comes men with prostate cancer (10 percent) and colon cancer survivors (10 percent).
(SOURCE: HealthDay News, CDC)
SENIOR SURVIVORS: While more and more seniors are surviving cancer, there are no clear-cut guidelines to help doctors make treatment decisions. "Older patients are much more complex than younger patients," Heidi Klepin, M.D., M.S., a geriatric oncologist from Wake Forest Baptist Medical Center, told Ivanhoe. "They are more likely to present with chronic medical conditions such as heart disease, diabetes, chronic lung disease. All of these increase the risk of complications with cancer therapy." Dr. Klepin says another problem is that clinical trials for cancer therapies typically do not include older individuals. "There's a lack of clinical trial data to say here's an effective therapy for a patient in this age group with this cancer. There are very few tools that an oncologist can use to assess a given patient," she said. Most treatment recommendations are based on chronological age.
(SOURCE: Ivanhoe interview with Dr. Klepin)
ASSESSMENT TOOL: Researchers from Wake Forest Baptist Medical Center used a simple assessment tool to determine how well older adults diagnosed with acute myelogenous leukemia (AML) can handle treatment. A study published in the Journal of the American Geriatrics Society looked at the bedside geriatric assessment (GA) to evaluate cognitive function, psychological state, physical function and co-morbid disease to identify patients who were most vulnerable to side effects of chemotherapy. The study involved 61 patients, and the mean age was 70.8. The researchers found, as a group, these patients presented with depressive symptoms, distress and physical function impairments and had more difficulty with mobility. "We found a significant percentage of patients who were going to start aggressive chemotherapy had limitations in physical function and cognitive function such as memory impairments," Dr. Klepin said. "We were picking up a lot of impairments that would not have been picked up by standard evaluation." Preliminary data also showed having impairments in these areas prior to starting treatment for AML was associated with shorter survival.
(SOURCES: Wake Forest Baptist Medical Center press release and Ivanhoe interview with Dr. Klepin)
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