For those of you who treat and take care of older adults with cancer, would you estimate that most of your patients are over the age of 65? This may be true for those of you working in a VA medical facility.
Clinical research and medical guidelines seem to be based mostly on studies of patients much younger and healthier than your typical patients. This is especially true if you work at a VA center, where patients face cancer diagnosis later in life.
According to Dr. Waddah B. Al-Refaie, MD, staff surgeon at the Division of Surgical Oncology at the Minneapolis VA Medical Center, most solid tumors occur in patients older than 65, yet the cutoff for screening is 80. Al-Rafaie said in a US Medicine article that many cancer clinical trials have limited applicability to the elderly, because the majority of the patients in those trials are younger, healthier, and insured. Many of the older cancer patients, especially in the VA health system, are smokers, have many co-morbidities, and are of lower socioeconomic status.
Operative research does not necessarily reflect all cancer populations across the board, especially within the elderly population. In the populations traditionally studied, colon cancer procedures are very common, and overall mortality is not necessarily very high, Al-Refaie said. By comparison, inadequate information is available in the areas of morbidity, complications, and length of stay within the elderly population.
Al-Rafaie and his colleagues want to remedy this knowledge gap by looking at oncology surgical outcomes in the elderly population. One recent study looked at 19,375 patients over the age of 40 who received colorectal cancer procedures. More than 20 percent of them were older than 80. With so many veteran surgical patients being elderly, higher mortality rates are of great concern. Death is obviously the greatest concern, but the study also predicts major health events and extended hospital stays for these patients.
Adverse events may increase with the elderly cancer population, but surgical intervention should not be prohibitive if that is the best option for your patient.
We have to keep in mind that many tumors (such as smoking-related lung cancers) may grow slowly, and patients may not be diagnosed until much later in life.
Do you feel that cancer screening should stop for people who are 80 or older? Should we restructure our cancer clinical trials/research to incorporate more of the older adult population?
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