I have been an advocate and proponent of addressing the special needs of the elderly with cancer for over three decades. I will take every chance I get to bring home the message that cancer is a disease of older adults. The recent publication by Siegel and colleagues1 in the July/August issue of CA: A Cancer Journal for Clinicians enlightens us to this critical imperative, particularly as it pertains to the elder majority of cancer survivors.
In this publication, the authors reported that nearly one-half (45 percent) of the 13.7 million American cancer survivors are aged 70 and older, while only 5 percent are younger than 40 years. The predominance of the elder majority in the diagnostic and treatment trajectory is comparable. In the United States, the most common age to be diagnosed with cancer is 66 years.
Twelve malignancies have a median age at diagnosis of age 65 or older (see table). Hence it is not just within the earlier phases of cancer that we must appreciate the geriatric imperative, it is also in the more extended survivorship paradigm that our attention is needed.
| Primary Cancer |
Median Age at Diagnosis |
| Urinary |
73 |
| Chronic lymphocytic leukemia |
72 |
| Pancreas |
72 |
| Lung |
71 |
| Colorectal |
70 |
| Myeloma |
69 |
| Esophagus |
68 |
| Prostate |
67 |
| Acute myeloid leukemia |
67 |
| Non-Hodgkins lymphoma |
66 |
| Small intestine |
66 |
| Chronic myeloid leukemia |
65 |
What then are the special needs of older cancer survivors?
Older cancer survivors are characterized by numerous unique defining characteristics that have not been quantified nor investigated. These include the fact that they require comprehensive screening for subsequent second and third primary cancers due to their heightened risk associated with advanced age. The prominence of co-morbid conditions may complicate early detection of these subsequent cancers.
The lack of rehabilitation programs that address the debilitation associated with curative therapies may prompt added functional decline and debilitation during extended survivorship. Social support may be lacking due to the mobility of adult children and the functional impairment of older siblings, friends, and spouses. Coping has its challenges. Older survivors may be plagued by survivor guilt or have to maintain optimism as to their future while mourning the loss of valued family members and friends.
The range of nursing opportunities to address older cancer survivors' unmet needs is far reaching. I would be interested in knowing if any readers have addressed the special needs of this important majority.
Reference:
- Siegel R., DeSantis C., Virgo K., Stein K, Mariotto A. et.al. (2012). Cancer treatment and survivorship statistics, 2012. CA – A Cancer Journal for Clinicians, 62(4): 220-241.
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