As a woman who has had breast cancer twice, I have lived through that “punch in the gut” feeling when your doctor first gives you that diagnosis and says “that word.” For me, both times, I never heard a single thing he said to me after he said “cancer” and I had to call him back to find out what else he wanted me to know. This is not atypical.
That diagnosis, for anyone, is a shock and brings with it fear, doubt, helplessness and sometimes hopelessness. And those feelings are natural and normal as well. I can also tell you from experience, that it is something that you can get through with dignity and with optimism.
But, it is increasingly obvious that there is much to be said and to be considered when the patient is an older adult, as it is becoming more evident that highly individualized treatment may be the new standard of care. The older adult is more likely to have experienced other health issues which makes weighing benefits and risks a number one priority.
There is substantive data that suggests there is a very real difference between chronological age and what could be termed functional age. For example a rather healthy adult who has few chronic conditions will tolerate aggressive therapy far more successfully than will a frailer person with several medical conditions or diseases.
It is a well-known that in most Western nations, the incidence and mortality rates for breast cancer rises considerably with increasing age, which signifies that physicians and oncologists will be faced with managing an ever rising number of older patients with breast cancer. For the physician, having the knowledge and tools to optimally treat this group will be essential.
A research article in a 2012 issue of Oncology Journal stated the following and this statement is still true today:
“The challenge of caring for an older cancer patient is to provide treatment options that maximize long-term survival and account for life expectancy, comorbidities, and the effects of treatment on function. For example, a mild treatment-induced peripheral neuropathy can transform a functioning elder into one who is dependent on institutional care. Complicating matters, there is a paucity of data from randomized trials
on the risks and benefits of our newer and increasingly effective treatment
in older breast cancer patients.”
The most important factor is that treatment of the older adult breast cancer patient must be individualized with both benefits and risks taken into consideration and this can be crucial to both remission and survival rates. From a physician’s point of view, Dr. Arti Hurria, in a 2017 interview with OncLive stated this perfectly:
“To understand what those risks are, you can utilize a calculator that can calculate the risk of chemotherapy toxicity. You can go to the Cancer and Aging Research Group website and you can plug in 11 easy questions about your patient, and you can find out where they fall on the risk of side effects from cancer treatment, chemotherapy in particular. It will also tell you how you can intervene to try to decrease those risks. The biggest point is that chronological age does not equal functional age. Age tells us very little about an older adult, and if we can deepen the way we think about this patient population, we can individualize treatment decisions for them.”
I found this calculator to be interesting. While it is somewhat general in nature, nonetheless it gives us a good ideas of the tools being developed for health care providers to help them address the many factor that could impact treatment.
Both of my cancers were discovered through annual mammographies. But I face even more challenges in staying ahead of cancer in that every single one of my family members three generations back have died from some form of cancer. I am the only one to have survived. I do not wake up every day in fear. Just the opposite. I am self-aware, get annual physical exams and tests and remain vigilant, but not afraid. I strongly believe in the concept of “listen to what your body is telling you.”
Cancer does not care who you are or how old you are But the best treatment for your cancer, especially if you are an older adult, should take in to account both your functional and chronological age. And keeping this in mind when seeking treatment can help all of us.
Connelly, Shannon. “Treatment Considerations in Older Patients With Breast Cancer.” www.onclive.com. Intellisphere, LLC. 9 August 2017. Web. Access 15 October 2017.
Jones, Ellen L, Ashley Leak, Hyman Muss. “Adjuvant Therapy of Breast Cancer in Women 70 Years of Age and Older: Tough Decisions, High Stakes.” www.cancernetwork.com. UBM Medica, LLC Oncology Journal, Volume 26, Issue 9. 12 September 2012. Web. Access 15 October 2017.