Cancer in the Older PersonThis section has been reviewed and approved by the Cancer.Net Editorial Board, 1/11 Key Messages
Aging Aging is a process that changes a healthy young adult into an older, potentially less healthy person, with an increased risk of illness, injury, and death. The aging process is complex—each person ages at a different rate. This means that a person’s actual age doesn’t reflect the physiologic age (an estimation of age based on how a person functions). Aging can weaken a person's ability to resist disease and disability and may affect a person's well-being, independence, and feelings of self-worth. It is also a risk factor for cancer. Physical changes associated with aging and their relationship to cancer Many older people experience physical changes that increase the chance of disease and disability and may interfere with cancer therapy. When preparing for cancer treatment, it is important to consider a person’s daily functioning and whether there are any co-existing conditions or chronic (long-term) illnesses. For example, age is associated with a gradual inability to accomplish daily activities, such as dressing, bathing, and using the toilet without assistance. These abilities are measured by two indices called the Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL). Learn more conducting a health assessment for an older adult with cancer. Older adults who are dependent in these areas have a lower life expectancy and tolerance of stress, including the stress of cancer treatment. Moreover, they are less likely to live alone and care for themselves. Examples of chronic illnesses that often accompany the aging process include:
Older age and undertreatment Even though cancer occurs most often in the older population, older people often receive less frequent screening for cancer, fewer tests to stage the type of cancer, and, in some cases, milder treatments or no treatment at all. Many studies show that people with cancer over age 65 are significantly under-represented in cancer clinical trials. In some of these studies, poorer care has led to shortened survival. Furthermore, many studies have shown that cancer treatment is beneficial for older people. Although some people associate older age with poor health, age alone should not determine treatment options. For example, an older person's overall health and ability to perform daily activities should also be evaluated. It is important that both the older person with cancer and his or her family be given enough information about treatment options, especially the risks, benefits, and goals of treatment to make informed choices. Decisions about cancer treatment are personal, and older people with cancer have a right to determine what is in their best interest. Emotional concerns and practical issues Older people with cancer often have a different set of concerns than other adults with cancer, which may affect how older people will cope with cancer and includes the following: Maintaining independence. For many older people with cancer, the biggest concerns are being able to take care of themselves and feeling they are still in control of their health and decisions. Cancer treatment may interfere with the ability to cook and eat independently, wash or bathe independently, walk, drive, or access transportation. Having to rely on others to care for them may not only be overwhelming but may not even be possible, especially if there are no family members or friends around to act as caregivers. In addition, many older people experience the loss of their primary caregiver, such as a spouse, and may not have other supportive adult relationships. Feelings of social isolation. Older people with cancer are less likely to have a support system in place, often because they have relocated to a new home or apartment, do not live close to family, or have experienced the loss of family members or friends. Sometimes, being isolated brings up feelings of depression and anxiety, which may interfere with treatment. Furthermore, coping with problems associated with cancer treatment may become difficult. Community resources, such as visiting nurse services and other agencies, can be set up ahead of time so the older person with cancer does not experience cancer alone. By sharing your concerns with doctors and social workers, you may receive useful tips and contacts with local resources. Spiritual concerns. Spiritual and religious concerns may also factor into decisions about cancer treatment. As with other issues, effective communication between the person with cancer, a social worker, family members, and trusted members of the religious community may be helpful. Financial concerns. For older adults, retirement, the death of the primary wage earner, and existing financial problems can contribute to limited financial resources to pay for cancer treatment and other related costs. It is important to discuss these needs with a health care provider, as there are many resources available to help. Learn more about managing the cost of cancer care.Physical limitations. Older people with cancer may have medical problems that limit their physical abilities and mobility. Creating a safe physical environment at home can help them cope. Simple measures, such as improving lighting, clearing the clutter in the home, and installing safety railings in stairs or bathrooms, may help minimize accidents or falls. A social worker or a visiting nurse service can help assess the home environment and suggest changes. Transportation. Access to treatment depends on reliable transportation. Older people undergoing cancer therapy may have a difficult time getting to doctor appointments, especially if the person no longer drives and is dependent on other transportation. Ask the nurses or a social worker about assistance with transportation needs that will allow the older adult to receive appropriate cancer care. More Information |
