What Is Geriatric Oncology?

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Cancer is a complicated journey at any age. But for seniors, who may be living with other conditions and diseases, some aspects of their care can be even more complex. Dr. Hyman Muss, director of the Geriatric Oncology Program at UNC Lineberger Comprehensive Cancer Center joins Patient Power to explain the concept of geriatric oncology and how it can help seniors.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Cancer is complicated at any age. But for seniors who are also living with other conditions and diseases the journey can be more complex.

Here to help us understand special situations that seniors face is Dr. Hyman Muss, director of the Geriatric Oncology Program at UNC Lineberger Comprehensive Cancer Center. Dr. Muss, for people that may not necessarily know what geriatric oncology is, can you explain, basically, what is it?

Dr. Muss:

Sure.  So geriatric oncology—fancy term really means taking care of cancer in older persons, and it’s important because in the United States today, the average age of a new cancer diagnosis is 67.  And when I tell that to people, they’re frequently shocked because our image and media tends to portray younger people with cancer illnesses.

So we have in the United States many older people with cancer.  We don’t have a lot of research information on older people with cancer, so we don’t always know the best ways to treat them.  And older people with cancer frequently come in with lots of other things, lots of other illness in addition to their cancer like heart disease or diabetes, other problems that are very important, sometimes more important than the cancer.  So we’ve tried with our program and nationally to try to develop programs to give the optimal care for every older cancer patient.

Andrew Schorr:

So, Dr. Muss, when a patient comes to you or someone in your group, I understand they go through what’s called a geriatric assessment.  Can you, kind of, walk us through this assessment?

Dr. Muss:

Sure.  So today if you’re an older person and you come in to be evaluated by a geriatrician, in addition to standard things that we ask in history and physical like about your cancer, we ask a lot of things about your function as an older person like can the patient dress themselves?  Can they pay their bills?  Can they go grocery shopping?

We want to know about their nutrition.  We want to know about things like falls.  It’s a very major problem in a lot of older people that lead to lots of other problems.  We need to know about social support.  What kind of family or friends do they have to help them manage their illness?

And we do things like cognitive function.  Frequently, older people will come in, and they can be cognitively impaired.  And we as physicians don’t have time to formally evaluate them.  So by just doing a little screening test, we can frequently figure out if someone’s really got a problem understanding us or having cognitive difficulties, which is very important.

And then lastly, we just figure out their home situation and see what other help we can give them.  So the assessment is—takes a little time.  We’ve become very expert at it here and many other places, and it allows us to dig into those problems in older people which frequently are not gone into much in the busy routine care of an average oncologist or internist or family practitioner.

Andrew Schorr:

Dr. Muss, you talked a little bit about cognitive issues.  Are there other unique situations or health conditions that seniors face that could affect their oncology care?

Dr. Muss:

Excellent question.  So there are many other conditions we’re concerned with, anything that will impede function like diabetes with nerve damage or heart disease that results in shortness of breath or chest pain, many other conditions—any other condition that really has effect on function and quality of life.

So we really need to integrate this into our plan to treat the older patient.  Frequently, people say well, when we take care of patients and discuss them, how old is that patient?  But really the real question is what’s the life expectancy of that patient because you can have two patients in their 70s in your office.

And one has got a lot of baggage and very sick and has a very short life expectancy, and another is coming in and playing tennis and doing lots of things and is annoyed because she wants to get on the phone and schedule her cruise.  And you’re late, and they’re very different.

And yet, they’re both the same age, so it’s not age alone.  It’s really your functional status.  And the geriatric assessment allows us to get a lot of top quality information to really estimate people’s life expectancy accurately, which really should be a part of the management of all older patients with cancer, because you need to know that to select the right treatment.

Andrew Schorr:                  

Do you feel that that seeing a geriatric oncology specialist can have a positive outcome?

Dr. Muss:               

Absolutely, because frequently you’ll get patients that you see, and let’s say they have a history of falls.  And the geriatricians know that falls frequently result in fractures, shortening of life, adverse quality of life.  If we pick that up in our interview, a lot of these patients can be helped dramatically by seeing a physical therapist or occupational therapist.

Likewise, if you had an older patient who’s lost weight, frequently, in older people they haven’t lost weight because they have some disease of their intestines.  They’re losing weight, even with cancer frequently, because they’re not eating properly.  They live alone.  They don’t cook meals.  Maybe they get Meals on Wheels.  So if you detect this, you can get social services involved and help with that patient’s care.

So there are lots of things that we can detect in these visits that we can fix, and then occasionally we find other problems like their diabetes is out of control.  And if we fix that, they’re going to be better able to tolerate any cancer treatments whether it’s surgery or radiation or chemotherapy or whatever is appropriate.

Andrew Schorr:                  

Dr. Muss, clinical trials.  Is this an option that seniors should consider?

Dr. Muss:               

God, we’re desperate for clinical trials in older people.  So if you look at all of the wonderful research we see every day and all the breakthroughs and you look at the average ages of the patients on those trials even—let’s take breast cancer for instance—they’re in their 50s.  But the average age of breast cancer patients is in their 60s.

So in an area like that, if you get a very promising therapy but it has some major side effects associated with it and you don’t have enough older people on that trial, it’s really hard to extrapolate the data, to move the data from a trial done in younger people to older people.

So we really need specific trials for older patients, or—and, I should say—we need to ensure that enough older patients get on mainstream clinical trials in the United States, which has been a major problem and remains a problem, although we’re still working on it.

Andrew Schorr:                  

Dr. Muss, any advice you would like to share?

Dr. Muss:               

So I—I’d like to just encourage all my colleagues and—in oncology to think about older care issues when you see older patients.  I tell patients to write down all your questions.  Make sure your doctor is really aware of your social situation, your functional ability, what you can do for yourself, and don’t be bashful to ask questions at that visit because it can really add a lot to your care.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on February 17, 2015