It was estimated that in 2015, 65.5 per cent of new cancer cases in Australian men will be diagnosed in men aged 65 years and over, and 55 per cent of new cases in Australian women will be diagnosed in women aged 65 years and over.14 Psychosocial changes associated with ageing and multiple co-morbidities in older people can influence the type of treatment and support required.25 The unique treatment and care needs of older people with cancer have been described as a new specialty termed 'geriatric oncology'.25
Studies suggest that changes associated with ageing can sometimes lead to older people receiving suboptimal treatment, or treatment that is not consistent with their personal preferences.25, 26 Some studies report that older people, compared to younger people, with aggressive lymphoma are less likely to be treated for cure and are less likely to survive for five years due to limited access to clinical trials.27
Beneficent ageism refers to a neglect of an older person's wishes. The older person's social role is distorted and health professionals assume an ability to represent their best interests without endorsement from them.28
Additional complications can arise in the older person due to co-morbidity factors. Comprehensive geriatric assessments may help to support decision making in relation to treatment plans for older people.8 Aging is highly individualised and often poorly reflected in chronologic age. The management of the older person with cancer should thus be based on assessment of physiologic rather than chronologic age.29 The following factors should be taken into account when assessing the older person with cancer:30-32
- functional status
- social support
- psychological state
- concomitant medications
- carer support.
Age-related changes are also associated with disease-specific issues. In NHL, the implication for the older person is decreased duration of complete response possibly secondary to increased circulating levels of interleukin-6.32
Provide an example of how each of the age-related factors may impact an older person affected by NHL.
Access the article Tools for assessing elderly cancer patients,30 and NCCN clinical practice guidelines for oncology. Senior adult oncology. Version 2.201432 (a free resource, but you must register and then click 'Remember me' to bypass the login page in future), and:
- Discuss benefits or limitations associated with using a geriatric assessment tool in an oncology setting
- Appraise current tools used for geriatric assessment in light of the essential domains of a comprehensive geriatric assessment
- Describe actions that could be taken to ensure the older person's treatment preferences are considered
- Explain how you would respond to concerns of a colleague that a person's treatment plan should be modified due to their age.