Geriatric Oncology
January / February 2005
It is a reality all physicians in primary care face each
day. Their older patients are more likely to be diagnosed
with cancer. And yet with the clear relationship between
advancing age and cancer — approximately 60 percent of
all cancers in the United States occur in patients older
than 65, according to the Geriatric Oncology Consortium — few
specialized programs exist to meet the unique needs of such
older patients.
As the nation’s population ages and the number of
older adults increases (typically divided into those over
65 and those older than 85), the demographics of cancer care
are expected to change dramatically. Compared to their younger
counterparts, those 65 years of age and older are less likely
to be offered appropriately curative therapy or participation
in clinical trials.
Lagging treatment may arise from self-stereotyping
by the older adults themselves, clinician practice patterns,
and a lack of interdisciplinary services. Yet, advances in
treatment and supportive care improve chances for disease-free
survival or chronically controlled disease for older patients
who have cancer.
With the demographics of our aging society and the availability
of curative therapies, the Joan
Karnell Cancer Center at Pennsylvania Hospital has developed Living Well: A Program
for Older Adults. Designed to meet the needs of cancer patients
over age 65, the program combines the expertise of an interdisciplinary
team in order to offer individualized care designed to optimize
development of successful treatment plans. The members of
the Living Well team include:
- Oncology physicians
and nurses
- Geriatrician
- Psychologist
- Nutritionist
- Social worker
- Physical/occupational therapists
- Music therapists
The Living Well team works in collaboration with a patient’s
primary care physician to ensure continuity of care. Patients
are evaluated through a comprehensive screening process,
including geriatric assessment, as needed, to better identify
a patient's physical, psychological, social and spiritual
needs and provide the best available treatment options. "This
is how geriatric care should be practiced," says David
Mintzer, MD, chief of hematology-oncology at Pennsylvania
Hospital. "You can’t just treat the cancer, you
have to treat the whole person."
Sarah H. Kagan, PhD, RN, an internationally recognized expert
on geriatric oncology, served as a consultant during the
program’s development.
She is an associate professor of gerontological nursing at
the University of Pennsylvania School of Nursing and was
named a 2003 MacArthur Foundation fellow for her work in
helping to improve health care for older cancer patients.
Dr. Kagan notes that cancer can present atypically in the
geriatric population. Different cancers in older people,
for example, may respond differently to treatment or the
cancer symptoms may present differently in those who suffer
from other chronic illnesses. "If we can succeed in
changing the mindset about how to care for cancer patients,
we can do so much more for older adults," she says. "Living
Well is a pioneer program because it provides comprehensive
assessment for the unique needs of older cancer patients
as well as optimal support to ensure that they can live life
to the fullest."
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