Older adults with cancer often have geriatric-specific syndromes and conditions, such as osteoporosis, cognition and mobility problems, anemia, and frailty. These conditions make treating cancer among older adults complex. Below are several journal articles and other resources on this intricate topic, organized by geriatric issue.
- Association of Cancer with Geriatric Syndromes in Older Medicare Beneficiaries: This Journal of Clinical Oncology (JCO) article presents research about the link between cancer and geriatric syndromes, including osteoporosis, urinary incontinence, and hearing trouble. Researchers studied Medicare Current Beneficiary Survey data from 2003 and found that older adults with cancer have more geriatric syndromes than older adults without cancer. The study also noted that some geriatric syndromes are more common for patients with specific cancers. For example, depression and osteoporosis are more common among patients with colon cancer, and vision, hearing, and eating problems are more common among patients with lung cancer
- UNC Videos—Core Lectures in Geriatrics: The Alliance for Geriatric Education in Specialties (“AGES”) Curriculum: This UNC Lineberger Comprehensive Cancer Center website offers free PowerPoint lectures on myriad geriatric oncology topics, including medication use and management, dementia and delirium, and aging. The site also provides educational videos and a guide for patients with newly diagnosed pulmonary embolism and deep vein thrombosis.
- Does This Patient Have Medical Decision-Making Capacity? In this JAMA article, Sessums and colleagues publish findings from their study of medical decision-making capacity in older patients. The authors reviewed 43 studies that evaluated medical decision-making capacity and found that incapacity is common and often unrecognized. The authors summarize the 4 components of medical decision-making capacity.
- Assessing Cognitive Function and Capacity in Older Adults with Cancer: It is imperative to adequately and correctly assess cancer among older adults and provide individualized therapy. However, cognitive impairment and multiple comorbid diseases prevalent among this age group often make it difficult to assess and treat these patients. This article in the Journal of the National Comprehensive Cancer Network discusses the most effective ways to assess older patients’ capacity to make treatment decisions and to determine readiness for a specific therapy. The authors state that the ultimate goal is to improve quality of life and provide better outcomes for this population.
- Cognitive Impairment in Older Patients With Breast Cancer Before Systemic Therapy: Is There an Interaction Between Cancer and Comorbidity? Among older women with breast cancer, those treated with systemic therapy sometimes report short- and long-term cognitive impairment. Mandelblatt, et al set out to determine if the impairment was detectable before systemic therapy or if, indeed, it is a side effect of the treatment. The study results, detailed in this JCO article, show that certain patient subgroups may be at an increased risk of pre–systemic treatment cognitive impairment.
- Measurement and Impact of Comorbidity in Older Cancer Patients: As the population of older adults with cancer increases, oncologists have shifted their focus to comorbidity—as most geriatric oncology patients are likely to have other diseases in addition to cancer. However, not much research has focused on how comorbidity affects prognosis. In this Critical Reviews in Oncology/Hematology article, Dr. Extermann explains how the design of geriatric oncology trials and decisions about trial endpoints (historically, mortality) must expand to address treatment tolerance, quality of life, and other applicable outcomes.
- Gait Speed and Survival in Older Adults: In this JAMA article, Studenski and colleagues detail findings from their study about the relationship between gait, or walking, speed and survival among older adults. Investigators reviewed gait speed data from more than 34,000 adults older than age 65 from nine cohort studies. The study found that gait speed of 1.0 m/s or greater was equally able to predict survival, compared to traditional survival assessments of age and/or sex.
- Subjective, Objective, and Observed Long-term Survival: A Longitudinal Cohort Study: How older adult patients perceive their prognosis is an important factor in choosing treatment. Yet little research exists on how well patients can actually estimate their survival. This study in JAMA Internal Medicine compares older adults’ perceptions of their survival with their actual life expectancy using Health and Retirement Study data.
- Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment: Older adults with cancer are more likely to be frail and are more susceptible to side effects from cancer treatment. But only two health status measurements—ECOG and KPS—have been created to assess fitness for this population. This article, featured in CA: A Cancer Journal for Clinicians, explores studies that have focused on health status assessment in older patients. The article discusses how these assessments can be applied to geriatric oncology care.
- Frailty in Older Adults: Evidence for a Phenotype: This study in The Journals of Gerontology uses Cardiovascular Health Study data from more than 5,300 subjects age 65 and older to examine the characteristics of frailty in older adults. The study defined frailty as a clinical syndrome that does not always accompany comorbidity or disability. The study results can be used to assess frailty in older adults and for research on interventions for these patients.
- Anemia and the Frail Elderly: This Seminars in Oncology article investigates the complex relationship between anemia and frailty in older adults. Anemia strongly predisposes or speeds up the development of frailty and its associated conditions, including decreased performance, falls, and death. Therefore, trials are needed to evaluate the efficacy of treatment for anemia in this population.
- Evaluation of a Pharmacist-Led Medication Assessment Used to Identify Prevalence of and Associations With Polypharmacy and Potentially Inappropriate Medication Use Among Ambulatory Senior Adults with Cancer: In this JCO article, researchers report findings from a study of polypharmacy (i.e., concurrent use of at least five but less than 10 medications), excessive polypharmacy (i.e., more than 10 medications), and potentially inappropriate use medication in older adults. The study found a high prevalence of all three of these medication issues. The authors state that these findings warrant better and more efficient medication assessments to optimize medication use for older adults.
- Polypharmacy in Older Adults with Cancer: This course, offered through the Oncologist CME Program, reviews the many definitions of “polypharmacy” and how they relate to older patients with cancer. It also focuses on how to evaluate polypharmacy in older patients with cancer and discusses the pharmaceuticals that may lead to adverse events in older adults.
- Telephone Monitoring of Distress in Patients Aged 65 Years or Older With Advanced Stage Cancer: Cancer and Leukemia Group B researchers launched a study focused on the role of telephone monitoring and/or provision of educational materials in decreasing distress among older patients with cancer. The study—detailed in this Cancer article—evaluated 131 older patients with cancer using a depression scale, a quality of life questionnaire, and social support survey. Outcomes were evaluated after 6 months. Findings showed that patients who received monthly telephone monitoring and who were referred for help when necessary had less distress, anxiety, and depression than those who just received educational materials.
- Cancer-Related Fatigue in the Elderly: Cancer-related fatigue is common in older adults and can impact quality of life. This Supportive Care in Cancer literature review determined that more research in this area is needed. In addition, the authors state that doctors should focus on noticing the symptoms of fatigue early and try to figure out issues or underlying comorbidities that could be contributing to the problem.