Perspectives on Comorbidity and Cancer in Older Patients: Approaches to Expand the Knowledge Base

Abstract

Not only do persons 65 years and older bear a disproportionate burden of cancer, advancing age is associated with increased vulnerability to other age-related health problems. Newly diagnosed older cancer patients who have lived into later years of life may have concurrent ailments (eg, diabetes, chronic obstructive pulmonary disease, heart disease, arthritis, and/or hypertension) that could affect treatment choice, prognosis, and survival. The clinician must often make cancer treatment decisions in the context of an older individual's pre-existing health problems (ie, comorbidity). Ways to produce reliable information on comorbidity that can be effectively used in evaluation of older cancer patients are urgently needed. What is the nature and severity of the older patient's comorbid health problems? How do other age-related conditions influence treatment decisions and the cancer course? How do already compromised older patients tolerate the stress of cancer and its treatment? How are concomitant comorbid conditions managed? At present, no established, valid way to assess comorbidity in older cancer patients exists. Such technology, with a solid conceptual and scientific base, promises a high positive clinical yield to assure quality cancer care for older patients if reliable and valid instruments can be integrated into oncology practice. Much preliminary scientific work must be performed. A synthesis of viewpoints on what to include in comorbidity assessment of older cancer patients and development approaches were expressed in a multidisciplinary working group convened by the National Institute on Aging and the National Cancer Institute. We share the key issues raised regarding complexities of comorbidity assessment and suggestions for scientific inquiry.

The effect of nurse navigation on timeliness of breast cancer care at an academic comprehensive cancer center

“…27 Because of comorbidities, older patients may have more difficult treatments and may face additional barriers, such as memory impairment, language deficits, and lack of transportation to the clinic. [27][28][29] Thus, patient navigation may be more effective in older patients because it aims to overcome barriers specific to this population. Older women may face barriers associated with scheduling appointments in a timely manner following diagnosis, perhaps due to a lack of understanding of the cancer care process.…”

Reduced muscle strength and functional performance in men with prostate cancer undergoing androgen suppression: a comprehensive cross-sectional investigation

“…Such adverse alterations in body composition aggravates the age-related loss of muscle mass (termed sarcopenia), which can further compromise muscle strength, physical function and independent living, particularly in older patients who may be approaching thresholds for disability. 10,11 Further, older prostate cancer patients are normally already at a greater risk for other comorbid conditions and physical limitations (for example, cardiovascular disease, diabetes, osteoporosis, skeletal fractures) 11,12 that can dramatically affect their muscle and physical function. However, the development of effective counter strategies requires a detailed understanding of the consequences of AST on physical adverse effects.…”

Myelotoxicity of carboplatin is increased in vivo in db/db mice, the animal model of obesity-associated diabetes mellitus

“…in obese children with acute myeloid leukaemia (AML) [32]. Meloni et al [33] found delayed granulocyte recovery and Although DM seems to be a strong independent factor influencing mortality of patients with malignancies [34][35], there are only a few observations about an increased myelotoxicity during chemotherapy. Srokowsky et al [36] demonstrated in elderly breast cancer patients that diabetic patients were more likely to experience toxicities of chemotherapy than were non-diabetic patients.…”