Planning
for the needs of aging cancer survivors represents a significant public health
challenge. Here's what needs to be done.
by Keith M.
Bellizzi |August 8, 2019
In the next few
decades, the number of adults living with cancer is expected to triple in size.
Age is the single
greatest risk factor for cancer. By 2030, according to the Centers for Disease
Control and Prevention, the population of Americans over the age of 65 will double.
The good news is that
early detection, innovative treatments and supportive care have turned many
cancers into chronic illnesses, one disease among other chronic health
conditions that older adults may experience. But these coexisting health
conditions are likely to complicate the treatment and management of older
adults’ cancer.
Our current
understanding of appropriate care for older adults with cancer and their unique
needs is limited. As an expert in cancer survivorship and aging, I see several
specific areas that warrant our attention.
Generational
differences
Cancer in older
adults is complex. For the elderly, cancer is often one of several
coexisting health conditions that they may be managing, such as
heart disease, arthritis or diabetes. Eighty percent of older adults with
cancer report two or more additional health conditions. One in four cancer
survivors between 65 and 74 years old have more than five concurrent health
conditions.
Eighty percent of
older adults with cancer report two or more additional health conditions.
Older adults with multiple chronic
conditions are more likely to have poorly coordinated care,
adverse interactions between medications and worse health outcomes. They also
tend to use more health care services and, on average, take six or more prescription
medications.
In older adults, the
late health effects of cancer can be different or exacerbated by age. For
example, cancer-related fatigue, reductions in cognitive function and
chemotherapy-induced peripheral neuropathy can pose unique
issues. The interplay between these treatment-related effects and
common age-related issues presents challenges for care of older adults with
cancer.
The psychological and
social experience of cancer can also differ markedly for young and older
adults. Roles, responsibilities and support systems change as people age.
Many young adults
with cancer are dealing with competing demands of work or family. Having fewer
demands as an older adult might make the disease more manageable in some
respects.
But a decrease in social
networks and support – such as retirement or living farther away from family –
may have negative effects. Many older adults will minimize their
distress, so not to burden their families and caregivers. This leads
to underdiagnosis of
treatable distress.
These effects can be
exacerbated by health care providers with competing priorities, short office
visits and no organizational support for psychosocial distress screening.
Health care providers
In 2008, the National
Academy of Medicine warned of a looming shortage of geriatric oncologists and
nurses, as well as a lack of interest among medical professionals in geriatric
oncology.
The number of oncology office visits required
by older adults with cancer is projected to surpass the available oncologic
workforce by 2020. What’s more, older adults may see up to 12
different health care specialists in a given year.
The National Academy
of Medicine has warned of a looming shortage of geriatric oncologists and
nurses.
Who should coordinate
this care? Oncologists are experts in the diagnosis and treatment of cancer,
but many older adults have competing health concerns that require more than
just an oncologist. Geriatricians are trained in managing multiple health
conditions and optimizing functional performance in older adults, but may be
less familiar with managing cancer.
We need to make a
concerted effort to foster collaborative care partnerships between geriatricians
and oncology – including geriatric nurses in both fields, as they are on the
front lines interacting with older cancer patients. A team of health
professionals could jointly share responsibility for managing the health of
older adults with cancer, exchanging patient data and information between the
team.
Research shows
that this type of
collaborative model leads to better cancer follow-up care,
health outcomes and effective management of coexisting health conditions.
Focus on the family
Cancer is a disease
that reverberates across the family system, leaving no one untouched. In fact,
research suggests that caregivers and family members often report higher
levels of distress than does the individual with cancer.
With more and more
cancer care delivered on an outpatient basis, coupled with the changing nature
of cancer as a chronic disease, there is a growing burden on family to help a
loved one manage their disease. Moreover, many older family members may
themselves be dealing with a chronic illness and other life stressors, adding
to the burden.
Research suggests
that providing psychological
and educational supportfor cancer caregivers and family members may
improve not only the health of patients, but the health of caregivers.
What’s next?
Planning for the
health care needs of our aging cancer survivors represents a significant public
health challenge.
What we know about
caring for cancer survivors is largely based on the experiences of adult survivors of child-onset cancer and
proactive groups of middle-aged breast cancer survivors. There is an urgent
need for additional research on the needs and care of the burgeoning geriatric
population.
In 2010, the U.S.
Department of Health and Human Services released a
report on multiple chronic conditions. It recommended including
older adults with multiple chronic conditions in clinical trials, facilitating
self-care management and promoting multiple chronic condition curricula in the
health care sector.
The report also
suggested educating the federal, private and public sectors about issues
related to multiple chronic conditions.
While this national
initiative is encouraged, it’s clear that the growing number of older adults
with cancer outpaces current efforts. If we want to successfully respond to the
demand, we must find ways to quickly conduct meaningful and targeted research
on this unique population. This can help us develop best practices and offer
high-quality care.
Keith M. Bellizzi is
an Associate Professor of Human Development and Family Studies at the
University of Connecticut.
This article is
republished from The Conversation under a
Creative Commons license. Read the original article.
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