A gerontologic perspective on cancer and aging

Abstract

Most people diagnosed with cancer are aged >65 years, and many diagnosed younger live to become older survivors. Geriatric oncology is becoming recognized as a specialty area within oncology. It focuses specifically on the functional impacts of the interplay of aging and cancer, including the role of comorbidities.Nevertheless, to the authors' knowledge, little attention has been given to cancer from a gerontologic and lifespan perspective, especially quality of life and psychologic impact. Research has shown that the amount and type of psychologic impact of cancer is highly variable and that part of that variation is related to age, in that older persons are often less affected in both negative and positive ways. Gerontologic concepts and empiric findings related to physical, psychologic, and social aging processes may serve as partial explanations for that agerelated pattern. Important potential contributors include psychologic factors, such as changes in future time perspective and goals, as well as social ones, such as roles and previous experience. The result is a complex interplay of factors that vary across persons but are covaried with age. Empiric findings regarding 1-year to 8-year prostate cancer survivors illustrate the age differences and the differential impacts of age itself and comorbidity. The use of gerontologic concepts to explain the age-related impact of cancer will benefit both research and clinical practice by providing a means to target interventions more effectively by taking into account the psychologic and social changes that often accompany aging. Cancer 2008;112(11 suppl):2569-76.2008 American Cancer Society.KEYWORDS: aging, gerontology, oncology, quality of life, psychology, psychosocial aspects, survivors, prostate cancer.T he intimate link between cancer incidence and aging is well understood in the medical community. Most of the major tumors occur in greater proportion in men and women over the age of 65 years.1-6 Many individuals diagnosed and treated earlier in life eventually become older cancer survivors because of the increased likelihood of long-term survival for many cancers. As a result, greater than 60% of the 10.8 million cancer survivors in the U.S. today are over the age of 65 years. 1,3 Despite the finding that older men and women are disproportionately affected by cancer, to our knowledge remarkably little attention has been given to cancer in gerontology and geriatric communities, and even less to aging processes in oncology. Fortunately, we are beginning to see changes in both sides of the equation, as reflected by a special issue of the Journal of Clinical Oncology on geriatric oncology and a recent Institute of Medicine workshop on cancer in the elderly. 7,8 Nevertheless, most of that

Factors influencing ICU referral at the end of life in the elderly

“…Less aggressive care is associated with better quality of life of the 149 patient and less burden on the family after their loved one died 17 . The benefitting role of the 150 geriatrician in EOL care has recently been described to be important in the oncogeriatric patient 151 12,13,14 . Most probably, the more patient-oriented approach of geriatricians (versus the disease-152 oriented approach of other specialists) leads to a less aggressive care for the dying elderly patient 14 .…”

“…The authors observed that 54% of very old patients received intensive care 27 before dying whereas most of these patients had stated that they did not want aggressive care 11 . The 28 role of the geriatrician in the assessment and management of frail elderly together with EOL care 29 has recently been described to be important in insuring a good quality of life in the oncogeriatric 30 patient 12,13,14 . 31…”

Factors Associated with Psychological Characteristics in Patients with Hepatic Malignancy before Interventional Procedures

“…With the difficulties associated with aging, it may not be surprising that distress is relatively common among the elderly. However, an initial research has shown that younger adults with cancer have a higher risk of reporting psychological distress than older adults with cancer (Blank et al, 2008). DOI:http://dx.doi.org/10.7314/APJCP.2012.13.1…”

“…Some other reports suggested that age may serve as a protective factor against psychological distress related to cancer (Carstensen et al, 2006;Blank et al, 2008;Forstmeier et al, 2008;Nelson et al, 2009). Our study demonstrates that age is associated with somatization and obsessive-compulsive tendencies as a risk factor, phobia and paranoia as a protective factor.…”

Impact of androgen deprivation on physical well‐being in patients with prostate cancer

“…Moreover, older adults are more likely to have a higher number of comorbidities and decreased functional reserve; thus, the relative contribution of treatment's adverse effects to physical well-being may be paramount in the treatment decision process and successful survivorship. 3 The primary goal of any treatment is to achieve optimal ''physical, mental, and social well-being, not merely the absence of disease or infirmity.'' 4 Physical well-being, among the most important factors attributed to a person's level of independence, encompasses physical performance, functional capabilities, and energy level.…”