2015 ASCO Educational Book - Treating Older Adults with Cancer, with Heidi D. Klepin, MD, MS, Miriam Rodin, MD, PhD, and Arti Hurria, MD

December 1, 2015
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In this podcast, Dr. Heidi Klepin, Dr. Miriam Rodin, and Dr. Arti Hurria, will discuss their 2015 ASCO Educational Book article “Treating Older Adults with Cancer: Geriatric Perspectives,” which explores some of the unique concerns that should be considered when older adults are being treated for cancer.



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

This podcast is part of a series featuring articles from the 2015 ASCO Educational Book.  Produced annually, the Educational Book is a collection of articles written by ASCO Annual Meeting faculty and leaders from ASCO’s other meetings. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology and serves as an enduring resource long after the Meeting concludes.

In today’s podcast, Dr. Heidi Klepin, Dr. Miriam Rodin, and Dr. Arti Hurria will discuss their article “Treating Older Adults with Cancer: Geriatric Perspectives,” which explores some of the unique concerns that should be considered when older adults are being treated for cancer. Dr. Heidi Klepin is an Associate Professor in Hematology and Oncology at the Wake Forest School of Medicine. Dr. Miriam Rodin is an Associate Professor of Medicine at the St. Louis University School of Medicine, and Dr. Arti Hurria is the Director of the Cancer and Aging Research Program at City of Hope.

ASCO would like to thank Dr. Klepin, Dr. Rodin, and Dr. Hurria for discussing this topic.

Dr. Klepin: Hello. My name is Dr. Heidi Klepin from the Wake Forest School of Medicine. I'm joined here today with Dr. Miriam Rodin from St. Louis University School of Medicine and Dr. Arti Hurria from the City of Hope. We will be sharing some of the key points from our 2015 ASCO Educational Book article titled Treating Older Adults with Cancer: Geriatric Perspectives and talking about its implications for patients and their loved ones.

By 2030, the largest growth in the US population will occur among individuals aged 80 and older. This demographic shift also means there's a rise in age-related diseases such as cancer. In fact, the majority of cancer diagnoses and cancer deaths already occur in individuals aged 65 and older. These older patients often have unique issues that complicate their treatment and currently, physicians don't have a lot of information and training on how to best meet these patients' needs. However, there are some basic principles of treating older adults with cancer that physicians and their patients should know. These principles can help better predict treatment outcomes and optimize informed care decisions. Dr. Rodin, are there any special assessment tools that physicians should use when making treatment decisions for an older patient with cancer?

Dr. Rodin: Yes, there are. A key part of decision making for older adults after cancer diagnosis is made is to understand age-related risk factors for treatment. Geriatric assessment is a tool that can be use to help predict an older adult's life expectancy and risk for negative effect due to chemotherapy known as toxicity. This type of assessment includes looking at how much assistance would daily activity as a patient needs, screening for cognitive impairment, asking questions about social support, assessing nutritional status, carefully reviewing medications, and identifying a patient's other medical conditions like diabetes and heart disease.


Dr. Klepin: Dr. Hurria, what do the results of a geriatric assessment reveal and what should a patient know about how the assessment will affect their treatment?

Dr. Hurria: The balance between optimizing the benefits and minimizing the harms of cancer treatment poses a major challenge to oncologists who treat older adult. This is because the average risk of an older adult experiencing serious chemotherapy side effects is about 50%, much higher than in younger patients. However, among older adults of the same age, there is still a lot of variability in how well an individual tolerates a given treatment. It's important to personalize our estimates of risk for each older patient rather than generalizing solely based on their age alone.

Geriatric assessments provide information that can identify vulnerabilities that may increase the risk of treatment complications and influence life expectancy. This type of information can help oncologists and patients weigh the risks and benefits of a given treatment. It can also help oncologist develop individualized treatment plans to best support an older adult throughout their treatment. The goal is to learn as much as we can about each older adult to make the most informed decisions and minimize treatment complications.

Dr. Klepin: Do oncologists make all of these decisions themselves?

Dr. Rodin: No, they don't. Ideally, an older patient should be cared for by a team. This team includes their primary care physician, their oncologist, and other specialists to whom these doctors refer a patient. For example, consultation with a geriatrician can help oncologist identify and plan care for the frailest patients and those with multiple medical conditions in addition to their cancer diagnosis.

Dr. Klepin: What does a geriatrician do?

Dr. Hurria: A geriatrician is a doctor who specializes in the care of older adults and has expertise in managing multiple medical conditions in the context of the patient's goals and preferences. Geriatricians frequently coordinate care among several specialitsts and provide guidance about treatment of a medical condition in the context of the patient's other medical conditions as well as the patient's wishes. A hallmark of their profession is to perform a geriatric assessment which includes an assessment of an individual's ability to complete their daily activities, memory and ability to make decisions, and emotional well-being.

These should be considered vital signs to be followed throughout cancer treatment for older patients. Involving a geriatrician in an older adult's cancer treatment is ideal. However, because not every older adult with cancer may have access to a geriatrician, there is a growing effort to train all oncologists on the principals of geriatrics and to provide practical assessment tools that oncologist can use to with their patients to help personalize cancer treatment decisions.

Dr. Klepin: I would like to thank Drs. Rodin and Hurria for their insights and we thank you for listening. Please view our article online at asco.org/edbook for more in depth discussion on this topic which may be useful to you in further discussions with your doctors or your loved ones. Thank you.

ASCO: Thank you Dr. Klepin, Dr. Rodin, and Dr. Hurria. Please visit asco.org/edbook to read the full article or visit www.cancer.net/olderadults for more information about the unique challenges faced by older adults with cancer.

Cancer.Net is supported by the Conquer Cancer Foundation which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high quality cancer care. Thank you for listening to this Cancer.Net podcast.