Crisis Looms in Care for Cancer Survivors as Baby
Boomers Fuel Ranks of Senior Citizens
Researchers point out issues to be faced by
oncologists, geriatricians, care providers that provide post-treatment
care to elderly cancer survivors
Dec. 10, 2008 On the heels of yesterdays
projection that cancer will replace heart disease as the worlds number
one killer by 2010, comes a report that the U.S. faces a crisis in being
able to handle the rapid growth in cancer survivors that is expected
among senior citizens. More than 6 or every 10 cancers are found in an
American age 65 or older.
This national health care crisis will develop in
the coming decades as the country's baby boomer population ages and a
growing number of older adults find themselves diagnosed with and living
longer with cancer.
That is the position of a team of researchers from
across the country who believe current prevention measures, screening,
treatments, and supportive care for older patients at risk of or dealing
with cancer are lacking in the US.
In a special supplement issue of the international
journal Cancer being released this month - Aging in the Context
of Cancer Prevention and Control: Perspectives from Behavioral Health
Medicine the researchers say there is an urgent need for clear,
evidence-based practice guidelines to assist physicians, oncologists and
others who provide short- and long-term care management to older adults
with cancer.
Only with more immediate research will proper
prevention efforts, screening, treatment approaches, post-treatment
survivorship and end of life care be put in place to serve this rapidly
growing population, the experts say.
They point to these indicators:
●
More than 60 percent of all malignant cancer diagnoses in the U.S. occur
in people age 65 or older.
●
There are an estimated 6.5 million adults age 65 or older currently
living with a history of cancer in the U.S.
●
That number will only go up as the country's baby boomer population ages
and the number of men and women age 65 and older currently about 36.8
million doubles by the year 2030.
●
Approximately 43 percent of these older men and women with cancer are
expected to survive for 10 years or more and approximately 17 percent
survive for 20 years or more after their initial diagnosis.
"The coalescence of three factors has the potential
to create one of the biggest public health problems our country has
faced in decades," said Keith M. Bellizzi, a cancer survivorship
researcher and assistant professor of human development and family
studies at the University of Connecticut.
"These are: the aging of the baby boomers, the age
sensitive nature of cancer, and the increased survival for those
diagnosed with cancer."
There is growing consensus, Bellizzi said, that
researchers and clinicians will need to take a multidisciplinary
approach to address this challenge incorporating perspectives from
geriatrics, oncology, behavioral medicine, and public health.
"Further alarming are two recent reports which warn
of a looming shortage of adult oncologists and geriatricians in the
coming decades," said Bellizzi, one of the Cancer supplement's lead
authors and a former scientist with the National Cancer Institute in
Bethesda, MD.
"Two pressing questions that need to be addressed
are:
1) Who and how will we care for the growing population of older
individuals with cancer, many of whom also will have competing health
conditions, and
2) what are the unique physical, mental and social issues that they
face. Regrettably, research has not kept pace with this growing
population."
Here are some of the critical issues facing the
country's growing population of older cancer survivors as presented in
the special supplement:
Prevention
There is a prevalent bias in the medical community
and the general public that believes since many older people suffer from
chronic disease, the focus should be on illness management rather than
prevention. (Smoking cessation programs being one example) Since little
evidence based prevention research exists in older populations,
physicians are often forced to make their own judgment calls.
Screening
In general, older adults are less likely to be
screened for cancer and are more likely to receive incomplete diagnostic
workups. Future research in cancer screening should be devoted to
developing or updating screening guidelines for older adults based on
clinical trials that actually include older adults, decreasing barriers
to screening when screening is found to be beneficial and leveraging
volunteer organizations to enhance the participation of older adults in
screening trials.
Treatment
Older adults are less likely to receive optimal
doses of chemotherapy compared with younger patients due to toxicities
and perceived complications. Age alone is inadequate in determining the
vulnerability or response to treatment. When carefully selected, older
patients can benefit from treatment or palliation. Use of a
Comprehensive Geriatric Assessment (CGA) is recommended to determine
which older cancer patients can benefit from treatment and which
patients may benefit more from palliative care. Importantly, the
patient's and family's values and preferences need to be taken into
account in deciding on an appropriate treatment approach.
Survivorship
Is it my cancer or am I just getting older? Trying
to disentangle the effects of cancer and its treatment from competing
health conditions like cardiovascular disease, diabetes and osteoporosis
on health outcomes is complex. Some studies suggest that older cancer
survivors may be doing worse physically and psychologically than
non-cancer comparison groups. More research is needed in this phase of
the cancer care continuum which will ultimately lead to interventions to
prevent or mitigate these adverse outcomes.
End of Life
Although preparation of living wills and
designation of a Health Care Proxy are mandated by Federal Law, studies
have identified numerous barriers to their implementation. We believe
more effective and efficient communication regarding prognosis among
patients, families and practitioners will improve decision making and
help patients with terminal disease gain better control over their
financial and health care decisions at end of life.
Notes:
The International Agency for Research
on Cancer (IARC) released the report yesterday projecting that cancer
will become the leading cause of death in the year 2010. See link to
story in sidebar or click here to story.
Participants in the
study included:
● Keith M. Bellizzi,
Ph.D, MPH
Assistant Professor
Human Development and Family Studies
University of Connecticut
● Suzanne M. Miller, Ph.D
Director of Behavioral Research and the Psychosocial and Behavioral
Medicine Program
Fox Chase Cancer Center
● Deborah J. Bowen, Ph.D
Clinical Professor
Boston University
Cancer Prevention Research Program
Fred Hutchinson Cancer Research Center
● Karen M. Mustian, Ph.D
Research Assistant Professor
NCI Biobehavioral Cancer Control Research Fellow
University of Rochester Cancer Center
Behavioral Medicine Unit
Keep up with the latest news for senior citizens, baby
boomers
Dec. 10, 2008 On the heels of yesterdays
projection that cancer will replace heart disease as the worlds number
one killer by 2010, comes a report that the U.S. faces a crisis in being
able to handle the rapid growth in cancer survivors that is expected
among senior citizens. More than 6 or every 10 cancers are found in an
American age 65 or older.