ASCO 2013: Top Five Things Oncologists Need to Know about Cancer in Older Adults
A workforce shortage of geriatricians and other health professionals trained and certified in caring for older patients with cancer is colliding with the aging of the population and the increasing number of older Americans with cancer. After describing factors contributing to these dual challenges, Arti Hurria, MD, outlined how using geriatric assessment tools to guide interventions and technology to integrate geriatrics and oncology care can facilitate quality of care for these patients.
Dr. Hurria’s comments came during the B.J. Kennedy Lecture she delivered at the 2013 ASCO Annual Meeting after receiving the B.J. Kennedy Award for Scientific Excellence in Geriatric Oncology. Dr. Hurria is Director of the Cancer and Aging Program at the City of Hope Comprehensive Cancer Center in Duarte, California, and a founding member of the Cancer and Aging Research Group.
Dr. Hurria’s lecture was entitled “Cancer in Older Adults: The Top Five Things Oncologists Need to Know.” The following highlights were excerpted from Dr. Hurria’s lecture.
#1. Cancer is a disease associated with aging, and the number of older adults with cancer is on the rise.
Dr. Hurria pointed out that 60% of cancers and almost 70% of cancer deaths occur in people over the age of 65. By 2030, she continued, “our largest shift in growth is going to be in the 80-plus population, a group where we really have had very limited data in best practices.”
#2. There is a shortage of health-care professionals equipped to meet the needs of the next generation of older adults, and innovative models are needed to enhance the geriatric competence of the workforce.
Crediting ASCO for leading the way in helping us understand the workforce needs in oncology, Dr. Hurria said that in 7 years there is going to be “a clear discrepancy between supply and demand.” Currently, in the United States, there is one geriatrician for every 2,620 patients over the age of 75, but by the year 2030, the number of patients per geriatrician is expected to increase to 3,798.
“This is going to have clear implications during our time as oncologists in terms of our workforce, and it is going to lead to evolving models of care,” Dr. Hurria said. “We are going to be partnering with our allied health professionals, physician assistants, and nurses. We’ll be involving rehab, pharmacists, and social workers to help us with this care. And probably most importantly, we are going to be partnering at home, with families, family caregivers, and home care aides,” Dr. Hurria said.
#3. The aging process is heterogeneous, and chronological age does not equal functional age.
Dr. Hurria enumerated the lessons of pediatrics—that treating a young population requires a unique skill set, that these patients have age-related changes in physiology, are vulnerable to toxicity, dependent in their daily activities, and that the long-term effects of treatment raise concerns in this very vulnerable population.
“These are the same things that make our geriatric population potentially vulnerable,” Dr. Hurria said. “In fact, it might be even a bit more complicated because in pediatrics there are clear milestones,” and for that population, chronological age generally equals functional age.
Aging is a more heterogeneous process, and for older adults, chronological age doesn’t equal functional age. Aging is, however, “associated with a linear decline in organ reserve,” which might not be obvious when you look at patients or their laboratory values. But the decline in organ reserve becomes apparent when you stress the patient, and “chemotherapy is the perfect physiological stressor that can unmask the decline in physiological reserve,” Dr. Hurria noted.
The good news, she said, is that patients can build this reserve at any age, through lifestyle changes and physical activity. “This is a really important lesson for us to share with our patients,” she added.
#4. Tools are available to identify at-risk patients, and geriatric assessments can guide practical interventions.
Developing a geriatric assessment for oncologists began about a decade ago and represents a melding of the fields of geriatrics and oncology. The assessment takes into account factors that identify individuals at risk for toxicity and factors other than chronological age that predict the risk of morbidity and mortality. It evaluates functional status, comorbid medical conditions, nutritional status, cognitive function, psychological state, social support, and whether the patient is taking other medications and if those could interfere with cancer treatment.
The model was internally validated, and Dr. Hurria reported that she and her colleagues are now working on externally validating it. “I hope to be able to share those results with you next year at ASCO,” she said.
Tools that are currently available can predict toxicity of treatments and survival of older patients with cancer and can uncover problems that might go undetected in a routine history and physical. These findings can lead to practical interventions, Dr. Hurria said. “What the question really comes down to is: Is it feasible to incorporate these tools into oncology practice?”
#5. Technology can be used to integrate geriatrics and oncology care.
Dr. Hurria asserted that geriatric assessment is feasible in oncology practice. “We can utilize technology to capture the information, predict the risk of chemotherapy toxicity, and pinpoint areas of vulnerability and areas that are practical interventions that we can think about ahead of time.”
Dr. Hurria’s colleagues at City of Hope have developed touch screen technology and have helped incorporate the geriatric assessment into this technology, she said. Others may use their tablet devices to keep and show summaries of results or risk prediction tools to start a conversation with patients about preparing together for high-risk situations.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
