Summary
With an aging population, it’s crucial that older patients with breast cancer have access to personalized care tailored to their specific needs.
“The incidence of cancer rises dramatically with age,” noted Hyman B. Muss, MD, Director of Geriatric Oncology at Lineberger Comprehensive Cancer Center. “In the U.S., the average age for a cancer diagnosis is now 67 years old. And yet, there are significant gaps in care when it comes to this patient population.”
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Original Article
How Can Oncologists Better Serve Older Patients With Breast Cancer?
Oncology Times
By Catlin Nalley
With an aging population, it’s crucial that older patients with breast cancer have access to personalized care tailored to their specific needs.
“The incidence of cancer rises dramatically with age,” noted Hyman B. Muss, MD, Director of Geriatric Oncology at Lineberger Comprehensive Cancer Center. “In the U.S., the average age for a cancer diagnosis is now 67 years old. And yet, there are significant gaps in care when it comes to this patient population.”
While the majority of people who are diagnosed with and die from cancer are older, they are often excluded from clinical trials and don’t receive care that has the potential to help them. “Older people have been shortchanged when it comes to top quality research devoted to them,” Muss said. “It is important that we work to change our culture as well as our approach to medical care for these patients.”
What makes these patients unique is the variable nature of their health status. “One 75-year-old may be extremely fit while another person of the same age is wheelchair bound,” he explained. “Chronologic age is not a measure at all of functional age. When individuals reach a certain age, we often picture very frail people, which is not always the case.
“This is problematic, especially with new advances in cancer, when older people frequently don’t have the option to pick treatments that may be more effective, simply because they are perceived as older and unable to tolerate it.”
At the Miami Breast Cancer Conference, Muss discussed how oncologists and other clinicians can better care for this patient population during his session, “Assessing and Customizing Treatment for Older Patients.”
Geriatric Assessment
The foundation for caring for this patient population is the geriatric assessment. According to guidelines from ASCO, this tool should be used for patients 65 years or older who are receiving chemotherapy, “to identify vulnerabilities that are not routinely captured in oncology assessments. Evidence supports, at a minimum, assessment of function, comorbidity, falls, depression, cognition, and nutrition (J Clin Oncol 2018;36(22):2326-2347).
This is key to ensure these patients are not only physically capable, but to also gain a better understanding of their mental health and social support. A patient may come to visit and appear to understand what was discussed, but did they? “It is important that clinicians don’t make assumptions,” Muss noted. “Asking a simple question, like ‘what did you have for lunch?’ can help gauge a patient’s mental status.”
However, with growing demands and an expectation to do more with less, physicians find themselves without enough hours in the day. “Time is a precious commodity,” noted Muss. “And it is especially important when caring for older individuals given that standard physicals and history taking do not give a full picture of these patients.
“For instance, how many falls has the patient had? Can they live independently? Can they use the phone?” he continued. “You almost never see that in a report. And so, assessing an older patient for treatment involves a number of considerations and takes more time.”
Key Takeaways
Ensuring older patients receive a comprehensive assessment is vital to matching them with the right treatment; however, it can be a challenge to find enough time to do so. During his presentation, Muss offered attendees practical tips and tools that will help them not only improve their care of older patients, but also manage their time effectively.
“I want to provide practical ways physicians, NPs, PAs, and other clinicians can give older people better care,” Muss said. “We want to give patients the best treatment possible that is still tolerable. There are a variety of tools available that can be used in the office and only take a few minutes.”
For instance, ePrognosis (https://eprognosis.ucsf.edu) is a quick and effective way to learn more about your patient’s individual needs. It is designed to help clinicians and older adult patients make cancer screening decisions. Tools like this provide a starting point for physicians when developing treatment plans for their patients.
Another important consideration when caring for older patients is understanding their goals.
“Compared to younger patients, this population may be more concerned about quality of life instead of enduring toxicities to live longer,” explained Muss. “It is very important to get the patient’s insight on what they value most.”
There are tools that can be utilized by any member of the care team to better understand the risks of different treatments. Not only do these tools provide important insights, but they also help physicians and their team make better use of their time.
“Tools, like ePrognosis, allow for better decision-making,” Muss said. “By conducting geriatric assessments and utilizing available tools, the physician will have a rich view of the best options for their patients.”
Catlin Nalley is a contributing writer.