Older Adults With Cancer Should Undergo Specialized Testing to Help Guide Treatment

Evaluations can identify the potential for drug interactions and predict whether older patients are fit for chemotherapy.
BY Beth Fand Incollingo
PUBLISHED April 22, 2019
As older adults represent a growing patient population in the cancer landscape, a variety of specialized testing may help to guide treatment decisions, according to researchers who presented at the Oncology Nursing Society 44th Annual Congress.

While there are 46 million adults over age 65 in the U.S. today, totaling 15% of the population, that number will grow to 98 million by 2060, totaling 24% of the population, said Diane Cope Ph.D., ARNP-BC, AOCNP, director of nursing and an oncology nurse practitioner at Florida Cancer Specialists and Research Institute in Fort Myers.

The fastest rise in growth is occurring in the group aged 85 to 94, she added, and between 2010 and 2050, it’s expected that the number of adults aged 85 and older will grow from 5.5 million to 19 million. By 2030, an estimated 70% of all cancers will occur in people aged 65 or older.

Many question whether this growing population can be treated with the same anticancer regimens as their younger counterparts with cancer, and therefore, the presenters – comprised of Cope; Sincere McMillan M.S., ANP-BC, RN, a nurse practitioner in the department of geriatric medicine at Memorial Sloan Kettering Cancer Center in New York City; and Rowena (Moe) Schwartz, Pharm.D., BCOP, associate professor of pharmacy practice at the University of Cincinnati James L. Winkle College of Pharmacy in Cincinnati – addressed why older adults should expect to undergo specialized testing to determine their fitness for various treatments.

Screening Tests

McMillan recommended that seniors take the following tests:
  • a geriatric evaluation that can determine if a patient’s functional status is different from their chronological age, identify deficits and health issues, and determine which patients face an increased risk of side effects from cancer treatment.
  • the Mini-Cog – a quick, brief screening tool that tests the ability to remember words.
  • assessments of how well patients are performing activities of daily living, such as eating, bathing and dressing, and instrumental activities of daily living, such as cooking, cleaning and taking medication.
  • the Timed-Up-And-Go (TUG) exercise, which tests how long it takes a patient to stand up, walk 10 feet at a normal pace, return and sit down again. This determines whether patients face a risk of falling and might need physical or occupational therapy.
  • the Geriatric Depression scale, which asks about satisfaction with life and level of motivation.
  • the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) and the Prediction Tool for Chemotherapy Toxicity created by the Cancer and Aging Research Group (CARG) – which combine a host of facts about an older patient’s health and abilities to predict whether they are fit for chemotherapy.

Based on all those results, Cope said, patients should be advised of their personalized risks and benefits from chemotherapy and asked for their perspectives and those of their caregivers.
Patients planning cancer treatment who have not undergone these tests should consider asking for them, so that their care teams have as much individualized information as possible on which to base their therapy plans.

Considering Polypharmacy

Polypharmacy is the use of numerous, inappropriate and duplicated medications or multiple pharmacies, or the underuse of medications, explained Schwartz, adding that any of these issues can cause adverse drug reactions or interactions, as well as contributing to increased complexity and cost of care.

Drugs can interact with other drugs or with food and can aggravate health conditions or affect a patient’s ability to function. Even combinations of over-the-counter drugs can result in issues such as fatigue or dizziness, Schwartz said. In oncology, she added, concerns are that drugs taken for other conditions might decrease or increase the effects of an anticancer medication or contribute to cumulative side effects. When polypharmacy is a factor, patients may be less likely to take all their drugs at the right times and doses.

Care teams can help by evaluating all the drugs a patient is taking and determining whether any should be stopped, Schwartz said. This should be done any time a drug is started, changed or discontinued, she added, and all doctors and pharmacists involved should be aware of these events.

Older patients and their caregivers should tell oncology care teams about all prescribed and over-the-counter drugs and supplements they are taking, along with any side effects, to help prevent the problems that can arise due to polypharmacy, Schwartz said.
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