ONCOLOGY AND AGING
KYLE ROBERTSON DISPATCH Richard Fisher, 75, has been treated for seven years after his colon cancer was diagnosed. One doctor told him he had six months to live. So he found another doctor who was willing to treat the disease.
Doctors, older patients rethink cancer treatments
By Misti Crane • THE COLUMBUS DISPATCH
Richard Fisher didn’t like the first answer he heard. Neither did his wife, Martha, or their three daughters. • “They came back saying there wasn’t much hope at all — six months if everything worked perfect,” said Mr. Fisher, who is 75 and lives in Prospect in Marion County. • He sat down with his family and decided to get a second opinion at the Arthur G. James Cancer Hospital in Columbus. • That was seven years ago. His diagnosis has not changed in that time. Fisher has stage-four colon cancer, meaning that the disease has spread beyond the colon. During that time, he enrolled in a clinical trial and took a series of chemotherapy drugs that have prolonged his life and given him quality time, he said.
“And in seven years, no one has ever, ever given us a time limit,” Mrs. Fisher said. “It’s wrong to tell anybody, even if they’re 80 or 90, that you have a time limit on your life.”
Experts in treating older cancer patients say it’s important to think of each patient individually, not to assume that because someone has reached a certain age that he or she isn’t going to be able to withstand surgeries, radiation or chemotherapy. On the other hand, a person’s frailty and other medical conditions must be part of the conversation when discussing the repercussions of those treatments, which often cause life-altering side effects.
Many oncologists (particularly those focused on geriatrics) are giving these issues heightened consideration and are spending more time with patients and families figuring out what’s best and not just what makes sense on paper.
“You want to think differently about how aggressive to be, but you also don’t want to write people off just because they’re older,” said Dr. Richard Goldberg, an oncologist at the James. More than half of new cancer cases each year are in those 65 or older. The average age for a diagnosis is 66, according to the National Cancer Institute.
“Aging is a very heterogeneous process,” said Dr. Arti Hurria, a cancer and aging expert at City of Hope National Medical Center in suburban Los Angeles and president of the International Society of Geriatric Oncology.
“Really understanding the whole person is key to understanding and making and advising treatment decisions.”
Goldberg said doctors are working to use more-objective approaches to help them understand how a patient measures up in terms of physiological age.
“What really matters is not chronological age, but functional age,” said Dr. Ewa Mrozek, an oncologist at Ohio State’s Stefanie Spielman Comprehensive Breast Center who is starting a clinic there to focus on older patients’ needs.
“Breast cancer is often only one of multiple coexisting health conditions that they have,” she said, adding that it’s important to focus not just on physical ailments but on cognitive and emotional health and on the patient’s ability to care for herself and get around.
Complicating discussions about how best to care for older cancer patients is the fact that in some cases there is limited data on how they respond to treatments.
- Most research has not focused on the response in older patients. But that’s beginning to change.
For example, the National Cancer Institute is emphasizing studies in aging patients, said Dr. Philip Kuebler, principal investigator for the Columbus Community Clinical Oncology Program. One study of a colon cancer treatment has helped doctors understand that cancers in those 70 or older are unlikely to respond as well to that treatment as cancers in younger patients, he said.
- In some cases, it might make sense to scale back the standard recommended care for certain age groups, he said. In others, it is worthwhile to discuss the person’s life expectancy and likelihood of a better quality of life without treatment, he said.
In addition to pointing out when to hold back, research can confirm the value of chemotherapy and other treatments in patients once thought to be too old, Goldberg said. “Sometimes it turns out that older patients can tolerate aggressive therapy and that ‘chemo-lite’ isn’t as good as a full dose,” he said.
Hurria said it’s important for research to focus on geriatric principles, such as the impact of treatment on maintaining independence and the way the cancer treatment interacts with the other medications patients take.
Kuebler said he is hopeful that as more trials open, older patients will want to explore new options.
If Mr. Fisher, the colon cancer patient from Prospect, is any indication, there’s promise.
Earlier this month, he was planning to meet with his treatment team at the James to talk about starting his second clinical trial. firstname.lastname@example.org
(Again, this is progress. Sounds hopeful. Until the full range of choices including less toxic therapies such as the Gerson Therapy, Dr Burzynski in Texas or Dr Michael Gonzales in New York and so many other natural, herbal or gentle approaches which don’t cut, burn or otherwise injure, I would have to say — we have a distance to go. Paramount is protection of ‘choice’ and honoring the freedom to have that. As long as there is discussion and an honest give and take– it’s all good. Jan)