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Why Worry About Cancer As We
Get Older
Trevor A. Jolly MBBS
Cancer and Older Adults: Care and Treatment
November 19, 2015
The Tsunami of Cancer and Aging
The US Population is Aging
US Population 65 and older
20
12
12.6
13.1
9.5
1965
1985
1990
2005
2030
Population Age 65+ in North Carolina,
2000
12% or less
12.1% to 13.0%
13.1% to 14.4%
14.5% to 15.9%
Mean = 12.0%.
More than 16%
Range = 6.3% to 23.6%
Population Age 65+ in North Carolina,
2030*
12% or less
12.1% to 13.0%
13.1% to 14.4%
14.5% to 15.9%
More than 16%
Mean = 17.7%.
Range = 10.5% to 35.2%
*Based on July 2006 population projections
Organ Reserve and Age
100
2
3
4
80
Percent
Reserve
Capacity
Remaining
1
5
60
40
1
2
3
4
5
20
0
0
Cellular Water
Kidney Blood Flow
Maximum Breathing Capacity
Nerve Conduction Velocity
Heart Output
20
40
60
Age (years)
80
Baker and Martin, Geriatric Medicine, 1996
Comorbidity and Age
Prevalence of various comorbid ailments by severity across the age spectrum.
Dementia
Prior Cancer
Diabetes
Heart Failure
HIV/AIDS
Hypertension
Piccirillo et al. Crit Rev Oncol Hematol. 2008 Aug;67(2):124-32.
Cancer incidence and Age
Age-specific cancer incidence rates/100,000 year 2000
The Median Age of a
Cancer Diagnosis in US
is 67 !
Erikson, C. et al. J Oncol Pract; 3:79-86 20070
Cancer Mortality and Age
Smith B D et al. JCO 2011;29:4647-4653
Cancer Survivorship and Age
18 Million Cancer
Survivors Projected
in 2022
Projected Future Need for Geriatricians
The Present:
1 Geriatrician: 2620
The Future:
1 Geriatrician: 3798
9000
8000
Number of Geriatricians
7000
6000
5000
4000
3000
2000
1000
0
2000
2010
2013
2020
2030
2040
2050
Year
Projected future need for geriatricians in 2030:
30,623
AGS: Geriatric Workforce Policy Study Center
Important Points
• The US population is aging
• Cancer is associated with age
• The number of older cancer patients and survivors
will increase
• The majority of cancer mortality occurs in older adults
• Other medical conditions increase with age
• There are not enough geriatricians to care for older
adults with cancer.
Assessing Older Adults
Assessing Older Adults
• Oncologist
– General
– Chronological age
– History and Physical Examination
– Functional Status
– Karnofsky performance status
– Eastern Cooperative Oncology (ECOG) Group performance
status
Age
Performance status
Tumor Characteristics
Age
Organ function
Polypharmacy
Comorbidities
Function deficits
Cognitive impairment
The Geriatric Oncology Iceberg
Falls
Psychosocial dysfunction
Nutritional deficits
Social Support
Geriatric Assessment….
The Value of Geriatric Assessment
Uncovers problems not found routinely
 Many problems have beneficial interventions

– Improve function
– Quality of life
– Survival
Allows for accurate life-expectancy estimate
 Can predict cancer related toxicity

Brief Geriatric Assessment
DOMAIN
ASSESSMENT MEASURE
Health Professional
Functional
Status
Co-morbidity
Cognition
Activities of Daily Living (ADL)
Timed Up and Go
Instrumental Activities of Daily Living
KPS- Physician Rated Karnofsky Self Reported
No. of Falls in the last 6 months
10
Blessed
Orientation
minutes
Memory-Concentration
Psychologic
Number /Type of Comorbid Conditions
No. of Medications
Vision and Hearing Assessment
20-30
minutes
Mental Health Index-17
Social Activity Limitation Measure (MOS)
Social Support Survey (MOS)
Social
Nutrition
Self Reported
BMI
Unintentional Weight Loss 6 mths
Deficits in Normal PS Patients
Frequency
(%)
PatientRated KPS
<50
60-70
80-100
Total
Professionally-Assessed KPS
<50
8 (0.8%)
10 (1%)
4 (0.4%)
22 (2%)
60-70
80-100
Total
3 (0.3%)
38 (4%)
28 (3%)
69 (7%)
8 (0.8%)
89 (9%)
796 (81%)
893 (91%)
19 (2%)
137 (14%)
828 (84%)
984 (100%)
Sarcopenia….
Molecular Aging….
p16 (CDKN2A)

Cyclin-dependent kinase inhibitor 2A
– inhibits CDK4

Codes tumor suppressor protein
– helps regulate the cell cycle
mutations increase risk of
developing a variety of cancers
 Increased expression with aging
 Ned Sharpless UNC world expert

Interventions….
Walking Intervention
• Leigh Callahan UNC
• Effective in Arthritis
↓ pain and stiffness
• Scalable
Pt sets pace
Can do anywhere
• Goal 30 min 5 x weeks
• Pilot trial In AI and now
R-21 randomized trial
HBM/June 2014
1/22/15
Thank You!