Over 60% of people who have cancer are 65 or older. In today’s podcast, we will discuss some of the unique challenges older adults with cancer may face, including special considerations for preparing for and recovering from surgery.
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.
Over 60% of people who have cancer are 65 or older. In today's podcast, we will discuss some of the unique challenges older adults with cancer may face, including special considerations for preparing for and recovering from surgery. This podcast will be led by Dr. Beatriz Korc-Grodzicki, the chief of geriatric services at Memorial Sloan Kettering Cancer Center. ASCO would like to thank Dr. Korc-Grodzicki for discussing this topic.
Dr. Korc-Grodzicki: Hello. My name is Dr. Beatriz Korc. I'm a geriatrician, and I work at Memorial Sloan Kettering Cancer Center where I see older adults who have cancer. Today we are going to talk about surgery for older adults with cancer, and what special considerations we have to consider for this cancer population. So I have a few topics that I would like to cover.
So the first is just a very short explanation of why focused geriatric service can be helpful for older adults with cancer. Geriatricians, in general, are experts in taking care of medically complex older patients, especially when considering therapies, such as the ones that are being considered for older adults with cancer. So it is important to look, not only at the chronological age of the patients, so how old the patient is, but also at their physiological age, meaning how good or how sick the patient is otherwise. So determine if that patient is fit or what we call frail. So a patient that is frail, in general, is more vulnerable to toxicities from therapies that are going to happen throughout the cancer treatment. So we consider somebody that is fit as a patient that has very few or no long-standing diseases, like heart disease, lung disease, pulmonary problems, have no functional deficits, are able to take care of themselves and of their homes, et cetera, and have no genetic syndromes, like they have no dementia or difficulties walking. A frail patient are those that have, on the other side, multiple long-standing medical conditions, or are in need of assistance in their daily living, or have some of the genetic syndromes that I mentioned before, like they have some memory loss or difficulties walking, urinary incontinence, et cetera.
So when we are going to consider a patient with cancer, what would be some unique concerns that we need to take into account? So we'd have to think that these patients may have less, what we call, physiological reserve, meaning that they're not as resilient as younger patients are. Sometimes they do not recover at the same pace, or the other medical conditions need to be taken into account when you are making considerations for the cancer treatment. Some patients have some more limitations in their activities of daily living. And that, in and of itself, may be a risk factor for loss of independence after cancer treatment. So as an example, just a very common problem, many patients, as they get older, have arthritis. And arthritis may lead to joint pain, like knee pain, or hip pain. And with those problems, they have less ambulation, they become more sedentary, and therefore they become more vulnerable and more possible of having a decline in their ability to take care of themselves in the house.
So if we are asking the question are there any special concerns that we should take into account when considering surgery, I would say that, yes, there are some vulnerabilities that we need to take into account, and we need to be more careful when we are talking about all of the above. And therefore the assessment for older adults needs to be a little bit more complex, more comprehensive, and needs to go a little bit beyond the traditional preoperative evaluation. So in a way that will reveal information that can be missed if you were just doing the usual evaluation of a history and physical exam. And the good results of surgery, for us, imply not only that the procedure was very successful, and the cancer was cured, but also that the patient remained with a good quality of life, avoiding cognitive decline, avoiding the need of institutionalization, and avoiding worsening of their other medical conditions.
So if you ask me, if I have some recommendations that they give to patients before or after surgery in order to optimize the recovery, I would say that there are quite a few things for patients to do as “homework,” between the moment they see me for the preoperative evaluation and the time of surgery. I'm quite a good believer of something that is called prehabilitation. That is what you can do for yourself before surgery in order to, in a way, try to improve outcomes, improve how we are going to function after surgery is over.
So what are those recommendations?
Number one, I ask my patients to increase physical activity: accelerated, nothing strenuous, go for walks daily - walks that can be a little longer than usual, a little bit more frequent than usual - aerobic exercising or stressing training, in your usual exercises but more often. All this while waiting for the date of surgery.
It's important to do breathing exercises. Some of the surgeons' office have something that is called an incentive spirometer that is just a very simple plastic gadget that you can blow into it and improve your breathing.
It's important that you keep very good nutrition. People that have weight loss, severe weight loss might benefit from a nutritional consult. But in general, smaller meals, more frequent, and always nutrition. And I always tell my patients to forget about the little snack here and there or the tea and crackers because it has no calories and it has no nutrition significance.
Another important aspect is just to be very aware of the anxiety that the surgery provokes and to take care of that anxiety, and to use relaxation techniques, mindfulness. Some people prefer meditation. Some people are good in yoga. Try to avoid medication for anxiety, but taking care of it is an important component of taking care of yourself before surgery.
I ask my patients to stop drinking alcohol. Some people used to drink one, two, three drinks with dinner on a general basis, sometimes for months or years, sometimes for the last 10, 20 years of their lives, and they do not understand how much they will miss the drink when they get in the hospital and they are going to be there for six, seven, eight days. So going down slowly or just stopping, several days, several weeks prior to surgery usually helps.
And last but not least is to make arrangements so you have what you need, the support that you need when you get back home. It is a very difficult problem when patients need to be readmitted for a fall, or for dehydration, and all the somersaults of not having adequate support at home when they get back from surgery. Going back into the hospital for a readmission after surgery is a very high risk for mortality.
It is important, and this is really the last piece of homework, to have a designated healthcare proxy whom you trust and a living will where you put your most dear-to-your-heart wishes, so the person that is your health proxy is actually knowledgeable about what you actually want, and your physician has the opportunity to have somebody to make decisions for you if you're not able to make decisions for yourself.
ASCO: Thank you Dr. Korc-Grodzicki. More information about cancer care for older adults can be found at www.cancer.net/olderadults. And for more expert interviews and stories from people living with cancer, visit the Cancer.Net blog at www.cancer.net/blog.
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.