Transcript Senior Adult Oncology

Senior Adult Oncology
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
Older Adults
Older patients can be classified into three
categories:
 Young Old: 65-75 years
 Old: 76-85 years
 Oldest Old: over 85 years
Age Distribution of U.S. Population, 1980,
1990, and 2005
Year 1980
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
Year 1990
Year 2005
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
Fraility Criteria

Unintentional weight loss (10 lbs or more in past year)

Self reported exhaustion

Weakness

Slow walking speed

Low physical activity
Geriatric Syndromes

Malnutrition

Depression

Polypharmacy

Dementia

Lack of Social
Support

Fall Risk
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
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
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
Percent of Medicare Beneficiaries Reporting Difficulty with
IADLs or ADLs by Age, 2004
35
30
Percent (%)
25
20
15
10
5
0
65-74
75-84
IADL Only
Data Source: Medicare Current Beneficiary Survey
1 to 2 ADLs
85 years and over
3 to 6 ADLs
Percent of Persons Age 65 and Over (age-adjusted)
Reporting Selected Chronic Conditions by Sex, 2004-2005
60
Male
Female
50
Percent (%)
40
30
20
10
0
Hypertension
Arthritis
Data Source: National Health Interview Survey
Heart disease
Cancer
Diabetes
Years of Education Among Persons Age 65 and Over
(age-adjusted) by Sex and Race/Ethnicity, 2006
70
Female
Male
Percent (%)
60
50
40
30
20
10
0
Less than High
School
High School
More than High Less than High
School
School
White non-Hispanic
Data source: Current Population Survey
Black non-Hispanic
High School
Hispanic
More than High
School
Cancer Treatment
Benefits:
 Prolonged
survival
 Maintenance
and improvement of quality
of life and function
 Palliation
of symptoms
Cancer Treatments
Risks:
 Complications
of surgery, radiation, and/or
chemotherapy
 Affects
on cognition, function, balance,
vision, hearing, continence, and mood
Treatment Decisions
 Life
Expectancy
 Aggressiveness of Disease
 Functional Abilities
 Comorbidities
 Patient Goals
 Social Resources
 Tolerance of Treatment
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