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Factoring in Age-Appropriateness For Cancer Treatment

It’s important to match therapies to goals and fitness when treating older patients diagnosed with cancer.
BY Len Lichtenfeld, M.D.
PUBLISHED February 19, 2020
A recent phone call reminded me how important it is to consider each patient’s goals when it comes to cancer care, especially as our population ages. As people live longer, I anticipate many will find themselves considering the goals and age-appropriateness of cancer treatment, whether for themselves or someone they love.

My caller described the unfortunate situation of a person over 70 with a diagnosis of advanced esophageal cancer that interfered with the ability to eat and function. Chemotherapy was prescribed in hopes of improving the disease, but toxicities were substantial, and death followed not long after treatment started.

Through all this, my caller related, no one asked the patient or family about their goals and desired outcomes, and there was no assessment of the patient’s functional capacities or ability to undergo such treatment.

The death left the family feeling they had failed their loved one in the final days of life when comfort should have been paramount. They felt they did not get the opportunity to have that important conversation with the cancer care team, and it left them anguished as they mourned their loss.

I shared with my caller that there are tools available to help oncology teams determine whether treatment may be helpful or too toxic for older patients.

The American Society of Clinical Oncology and the National Comprehensive Cancer Network offer excellent online information for doctors, patients and families to help guide treatment in the older patient. This topic is also getting more attention in the general media, given its obvious human interest and impact in an aging society.

Last year, my colleagues at the American Cancer Society devoted the Special Section in our Cancer Facts & Figures report to “Cancer in the Oldest Old”, highlighting the needs of patients who are part of the fastest-growing population in the United States — people age 85 and older.

As more people remain active into their later years, we must recognize that not all of us are alike: Some may be receptive to more aggressive cancer treatment and physically able to tolerate it, whereas others are not. Just as each person’s cancer has unique characteristics, so should treatment decisions be fit to the person, not the person to the treatment.

Cancer is, at best, a difficult disease. Treatment frequently has significant side effects. Together, we must understand that patients won’t get the treatments best for them unless they and their care teams have a mutual understanding of each other’s goals. Overlooking that may leave the patient and survivors with a very real — and perhaps unnecessary — added emotional burden.

Treatment for the sake of treatment may not always be in the patient’s best interest. It should always be about the person.
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