Transcript No Slide Title

FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners
Forte, D.1 McGregor, R.2
Population ageing in
United Kingdom
Slide One
• Currently over one fifth of the
population is over 60 years
• By 2025 those over 80 years will
increase by almost 50%
• By 2025 those over ninety will
have doubled
• Estimated percentage of older
people 65 years or more in
population in 2004 is 15%
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Incidence of cancer in
older people
Slide Two
• Cancer generally increases with
age
• Incidence of most malignant
cancers increase with age up to
85 years
• Decline in these cancers after
95 years
• 12% of newly diagnosed breast
cancer patients are 80 years or
more
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Three
Link between cancer
and old age
The link between old age and cancer
is the result of three main factors
according to Repetto & Balducci
(2002)
•
Substantial length of time
required for carcinogenesis
•
The occurrence of age related
molecular changes that mimic
carcinogenesis
•
Changes in bodily environment
that favour cancer progression
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
What do we mean by
ageing?
“The universality of ageing places it
Slide Four
outside the realm of pathologic study.
The changes that occur are normal
for all people but take place at
different rates and depend on
accompanying circumstances in an
individual’s life”.
(Ebersole & Hess 1998, p85)
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Five
Challenges of
chronological ageing
versus biological ageing
•
Ageing varies not only among
individuals but within different systems
of the same person” (Eliopoulos 1997
p45)
•
“Aging is a highly individualised
process, demonstrated by the
differences between persons of similar
ages” (Eliopoulos 1997 p45)
•
Chronological ageing is an indicator of
the number of years lived but is only a
crude indicator for ageing
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Six
Loss of function in old
age and implications for
cancer (1)
• Nervous system
10%
• Basal metabolic rate
15%
• Cardiovascular system
30%
• Pulmonary system
50%
• Renal system
30%
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Seven
Loss of function in old
age and implications for
cancer (2)
• Bone marrow
• Reduced tissue repair
• Changes to sensory system
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Are cancer services
inherently ageist?
Slide Eight
• Often older people receive less
screening for cancer
• They are less likely to be referred
to a main cancer centre
• Once diagnosed, often receive
less aggressive treatment leading
to an increase in mortality from
the cancer rather than
comorbidities
• Problems related to early
detection of cancer
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
The National Service
Framework for Older
People
Slide Nine
(DoH, 2001)
has as its first standard, the need to
root out age discrimination in the
health service. It states that:
“NHS services will be provided;
regardless of age, on the basis of
clinical needs alone”
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Ten
Older people and access
to clinical trials (1)
• Researchers indicate that for all
cancers, older people are underrepresented in clinical trials. This
is due to
• The strict exclusion criteria built
into many research protocols
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Eleven
Older people and access
to clinical trials (2)
•
Older people often present with
comorbidity which pre dates the
diagnosis of cancer and which many
clinicians feel makes the older
person too vulnerable for the more
aggressive forms of treatment
•
Misconceptions about ageing and
cancer may have a negative effect
when it comes to influencing clinical
decisions about treatment
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Problems related to early
detection and access to
treatment
Slide Twelve
• Effects of ageism on early presentation of
symptoms
• Signs and symptoms of cancer can be
vague and non specific
• Clinical presentation may be slow to
develop and be masked by other age
related physical changes and comorbidities
• Importance of raising awareness of early
detection in older people.
• Need for comprehensive assessment by
multiprofessional team
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Screening (1)
Slide Thirteen
Breast
• A 30% reduction in mortality from
breast cancer in the last 10 years in
the United Kingdom
• The figures are similar in the USA
but have remained static in Europe
(Rosin, Cancer Services
Collaborative 2001)
• By the end of 2004 all women in the
United Kingdom will be offered
routine breast screening
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Screening (2)
Cervical
Slide Fourteen
• Screening is estimated to save around
1,300 lives per year
• Primarily aimed at people under 65 years
• Need for older women to be included in
routine screening
Prostate
• The evidence for prostate screening is less
clear than for other cancers
• PSA testing fails to differentiate between
slow and fast growing prostate cancers
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Screening (3)
Slide Fifteen
Bowel
• The incidence increases with age
and is mainly a disease that
affects older people
• In 2000 the National Cancer
Plan announced that it would
implement a pilot study to look
at the population most likely to
benefit from bowel cancer
screening
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Comprehensive
assessment
Slide Sixteen
• Needs to include:
• Biographical data
• Physical assessment
• Psycho/social assessment
• Cultural preferences
• Multidisciplinary input
• Patient and carer involvement
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Seventeen
Single assessment
• Should facilitate better
communication within and
between teams, and other
service providers with whom the
older person has contact
• Reduces the need for the older
person to repeat the same
assessment information to a
variety of service providers at a
time when they are feeling
vulnerable
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Eighteen
Key assessment areas
for older people at risk
of cancer
• Physical
• Psychological
• Social
• Spiritual
• Financial support
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Nineteen
Key assessment areas
for older people at risk
of cancer
• Comorbidity
• Natural ageing process
• Understanding of the impact of
multi-pathology/chronic
illness/cognitive impairment
• Thorough assessment of past
medical history and medication
• Identifying risk factors including
smoking, nutritional status
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Twenty
Key assessment areas
for older people at risk
of cancer
Psychological state (1)
• Impact of cancer on the older
person’s sense of wellbeing
• Motivation and adjustment to
the situation
• Quality of life
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Twenty one
Key assessment areas
for older people at risk
of cancer
Psychological state (2)
• Psychological support
• Cognitive function
• Sexuality and self image
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Twenty two
Key assessment areas
for older people at risk
of cancer
Social assessment needs to consider:
• Social support networks
• Carer support
• Housing
• Finance
• The older person’s perception of
health
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Summary
Slide Twenty three
• Need for more research
• Greater consideration of the
impact of ‘normal’ ageing changes
• Rights of older people to being
told their diagnosis and the
options available to them
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
Slide Twenty four
References and further
reading
• Bouchardy C., Rapiti E., Fioretta G., Laissue P., NeyroudCaspar I., Schäfer P., Kurtz J., Sapprino A. & Vlastos G.
(2003) Undertreatment strongly decreases prognosis of
breast cancer in elderly women. Journal of Clinical
Oncology. 21 (19): 3580-3587.
• Cooley C. & Coventry G. (2003) Cancer and Older
People. Nursing Older People. 15(2): 22-26.
• Cunningham S. (1996) The biological basis of cancer.
British Journal of Nursing. 5:14 869-874.
• Department of Health (2000) NHS Cancer Plan for
England. Department of Health. London.
www.doh.gov.uk/cancer/cancerplan.htm
• Department of Health (2001) National Service
Framework for Older People. Department of Health.
London
• Ebersole P. & Hess P. (1998) Towards Healthy Ageing, 5th
edition, Mosby. Missouri.
• Eliopoulos C. (1997) Gerontological Nursing. 4th edition
ch.4:p44-52; ch.7:p74-94. Lippincott. Philadelphia.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
References (continued)
Slide Twenty five
• Fee L., Cronin A., Simmons R. & Choudry S. (1999)
Assessing older people’s health and social needs. Health
Education Authority. London.
• Gearing B. & Coleman P. (1996) Biographical Assessment
in Community Care, in Birren J.; Kenyon G.; Ruth J.;
Schroots J. & Svenson T. (1996) Ageing & Biography:
Explanations in Adult Development. Springer. New York.
Chapter 15:265-282.
• Girotto J., Schreiber J. & Nahabedian M. (2003) Breast
Reconstruction in Older Women: Preserving Excellent
Quality of Life. Annals of Plastic Surgery. 50(6): 572-578.
• Heflin MT, Cohen HJ. (2001) Cancer screening in the
elderly. Hospital Practice. 36(3): 61-9.
• Lewis J., Kilgore M., Goldman D., Trimble E., Kaplan R.,
Montello M., Houseman M. & Escarce J. (2003)
Participation of Patients 65 Years of Age or Older in
Cancer Clinical Trials. Journal of Clinical Oncology.
21:1383-1389.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
References (continued)
Slide Twenty six
• Lichtman S. & Zaheer W. (1996) Breast cancer
screening is underused, although clearly beneficial, in
elderly women. Primary Cancer Care. 16(5): 5-6.
• Matsushita I., Hanai H., Kajimura M., Tamakoshi K.,
Nakajima T & Matsubayashi Y. (2002) Should Gastric
cancer Patients More Than 80 Years of Age Undergo
Surgery? Journal of Clinical Gastroenterology. 35(1): 29-34.
• Nolan M. & Caldock K. (1996) Assessment: identifying
the barriers to good practice. Health & Social Care in
the Community. 4(2): 77-85.
• Patel S. & Zenilman M. (2001) Outcomes in Older
People Undergoing Operative Interventions for
Colorectal Cancer: Surgery for Colorectal Cancer in
Older Patients: A Systematic Review. Journal of the
American Geriatrics Society. 49(11): 1561-1564.
• Posner R. (1995) Ageing and Old Age. The University of
Chicago Press, Chicago.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
References (continued)
Slide Twenty seven
• Reinbart Ayres M. (2004) Cancer and the Older
Population: Considerations for Healthcare
Professionals. Topics in Geriatric Rehabilitation. 20(2): 7580.
• Repetto L. & Balducci L. (2002) A case for geriatric
oncology. The Lancet Oncology. 3(5): 289-297.
• Robinson J. & Turnock T. (1998) Investing in
Rehabilitation. Review Findings. Kings Fund. London.
• Rosin D. (2001) Breast Cancer – Cancer Services
Collaborative
http://www.nelh.nhs.uk/nsf/cancer/breast_sig/summary
/summary-intro.htm
• Schmitt C. (2004) Treatment Strategies for Colorectal
Cancer in Older People. Journal of Clinical
Gastroenterology. 38(5): 387-389.
• Thomé B., Dykes A., Gunnars B. & Hallberg I. (2003)
The Experience of Older People Living With Cancer,
Cancer Nursing, 26(2): 85-96.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
December 2004
Older People and Cancer: Considerations
for Healthcare Practitioners (continued)
References (continued)
• Turner N., Haward R., Mulley G. & Selby P. (1999)
Cancer in old age – is it adequately investigated and
treated? British Medical Journal. 319: 309-312.
Slide Twenty eight
• Vardaxis N. (1995) Pathology for the Health Sciences.
Churchill Livingstone. Edinburgh.
• Westin E. & Longo D. (2004) Lymphoma and myeloma
in older patients. Seminars in Oncology. 31(2): 198-205.
• Wyld L., Garg D., Kumar I., Brown H. & Reed M. (2004)
Stage and treatment variations with age in
postmenopausal women with breast cancer:
compliance with guideline. British Journal of Cancer.
90(8): 1486-91.
• Yancik R., Wesley M., Reis L., Havlik R., Edwards B. &
Yates J. (2001) Effects of age and comorbidity in
postmenopausal breast cancer patients aged 55 years
and older. JAMA. 285(7): 885-92.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc