HY 09/08: Cancer in the Elderly | Lehigh Valley Hospital

As we age, our treatment and care decisions change

Cancer is a scary reality facing more than six in 10 people over age 65—and as we live longer, the number of new diagnoses is expected to increase. But the implications of cancer, including treatment decisions, can be different in an older person.

For example, while advanced age puts you at higher risk for common cancers such as breast and prostate, these cancers sometimes behave less aggressively than in a younger man or woman, says geriatrician Francis Salerno, M.D., of Lehigh Valley Hospital and Health Network.

Anyone diagnosed with cancer faces tough treatment decisions, and age alone is not the primary factor, says Gregory Harper, M.D., an oncologist at the hospital. “The patient’s desires and how well he or she is functioning physically are far better predictors of how a patient will do with cancer treatment than age alone,” he says.

But age-related issues do add to the complexity. “Often, older adults have heart disease, arthritis, high blood pressure and other conditions that can affect cancer treatment and recovery,” Harper says. For example, a person whose kidney function has declined excretes drugs more slowly, raising exposure level.

“Fortunately, we have lots of treatment options to choose from,” Harper says. Some older patients with other health problems can receive chemotherapy or radiation in regimens that are less toxic but still effective. In slow-growing cancers— prostate, for example—the decision often is “no treatment.” The patient eventually dies with the cancer, not from it.

“With certain cancers, we have had success with targeted therapies,” says Harper’s colleague, oncologist Eliot Friedman, M.D. “Unlike chemotherapy, which attacks all cells, these drugs attack only cancerous cells. There are some side effects, but they are less severe than the hair loss, nausea, fatigue and others associated with chemotherapy.”

“For some, the choice may be palliative care,” says family medicine physician Michelle Dilks, D.O. “For people who choose to forgo treatment, we can help them live as comfortably as possible by controlling their pain and other symptoms.”

When faced with a cancer diagnosis—or even before— Salerno suggests asking yourself: How do I want to spend the next part of my life? “Then talk to your family and doctors,” he says. “You may want aggressive treatment to gain enough time to attend a granddaughter’s wedding. Or you may choose to receive hospice care at home with your loved ones.”

What doesn’t change with age is the importance of cancer screenings. Talk to your doctor about the screenings you should receive and how often.

Want to Know More about living long and healthy? Call 610-402-CARE.

Published from Healthy You Magazine, September-October 2008