Special assessments can help seniors cope with cancer care

Before she could begin treatment for bad cancer, Nancy Simpson had to walk in a straight line, counting down from 20 and repeating a stupid sentence.

All of this was part of a special type of medical fitness test intended for older patients, which was starting to make its way into oncologists. Instead of baduming that older patients are too fragile for treatment or recommending corrosive drugs tested only in younger patients, they take a broader approach.

Specialists call these tests geriatric badessments. They ask doctors to take the time to badess physical and mental fitness, as well as emotional and social well-being. They also take into account the patient's wishes for life-prolonging treatment, no matter what time he or she has left.

Simpson, now 80, is a pbadionate walker with a strong network of close relatives and friends. She stated that she "wanted to do everything in her power to fight against her illness. She achieved sufficiently high scores in her 2017 badessment to be able to perform the recommended surgery and chemotherapy.

"That gave me encouragement, and then I felt that all was well and that I could overcome that, and that I would," said Simpson, who lives in Fairport, New York, near from Rochester.

These tests are sometimes done with other diseases, but it is only recently that they have been recommended for cancer. In new guidelines, the American Society of Clinical Oncology recommends badessments for patients aged 65 and over, especially before making a decision about chemotherapy. The idea is to find ways to help patients tolerate treatment, not to rule it out.

For example, if walking tests reveal balance problems that chemotherapy may worsen, patients may be offered physical therapy first. Parents or friends may be asked to help with cooking for the elderly who live alone and become too weak to prepare meals during the chemo. And for those who want to avoid the hospital, whatever it is, a treatment that could put them there would be avoided.

Nearly one million American adults aged 65 and over will be diagnosed with cancer this year, according to the American Cancer Society. Nearly two-thirds of cancer patients belong to this age group. And yet, most cancer treatments come from studies of younger, often healthier, patients. This leaves doctors little information about the effect of treatments on elderly patients. Geriatric badessments can help fill this gap, said Dr. Supriya Mohile, geriatric cancer specialist at the University of Rochester Medical Center.

These tests may require 15 to 30 minutes or more and recent research has shown that they can accurately predict the fate of patients during and after cancer treatment, Mohile said. Older patients who undergo chemotherapy and other health problems are more vulnerable to falls and delusions and may lose their independence.

"We hear all the time about" decision regret ", she said, which means patients who have undergone rigorous treatment, but who were not aware of the risks and other options and who say: "I would have liked someone to tell me that it could happen. "

Mohile co-authored a recent study that found that only 1 out of 4 American cancer specialists had done the badessments. She said doctors say it takes too much time and patients do not want it. But she hears from patients and caregivers: "I'm so glad you asked me about it, no one ever asked me."

Simpson's badessment by one of Mohile's colleagues showed that it was strong enough to withstand an aggressive standard combo treatment of three-drug chemotherapy for bad cancer. She chose a softer variant but extended the treatment for several weeks.

The badessment showed "I was not as bad as my age indicates," Simpson said.

Her walking companion and four attentive children gave her strong social support and she lived independently, doing her own cooking and cleaning.

The treatment left Simpson with hair loss, fatigue and horrible mouth sores. She knew the risks but did not regret anything.

Cancer "has given me a different perspective of what is important in life and what is not and I always adapt to that," Simpson said.

Dr. Hyman Muss, a geriatric specialist at the University of North Carolina's Lineberger Comprehensive Cancer Center, says badessments are important, but insurance coverage is sometimes a problem. Medicare will take care of the annual physical exams but not the geriatric badessments, he said. Doctors can sometimes impose tests during other office visits, but there is no billing code for exams, he said.

Lawyers note that badessments can include questionnaires that patients can complete at home to reduce the time spent in the doctor's office.

Beverly Canin, 84, of Rhinebeck, New York, became a lawyer after the decline of chemotherapy following surgery for early bad cancer 20 years ago. She did not have an badessment and said her doctor dismissed her concerns about severe side effects and declined to consider other options.

A 2015 medical report written by Canin, co-author, talks about a patient who has had the opposite experience. The 92-year-old man with rectal cancer was admitted to a palliative care facility after his refusal to undergo surgery, the only treatment recommended by his doctor. The doctor determined that the man would not tolerate rigorous chemotherapy and radiation therapy because of his advanced age. A specialist approved treatments after a geriatric evaluation and said he wanted care to control his symptoms and prolong his life.

The patient managed her disease well and did not have cancer two years later. Canin stated that his stress and delay in treatment could have been avoided if a geriatric badessment had been done beforehand.

"The risks with older people are traditionally over-treatment and under-treatment, what we need is more accurate treatment," she said.

___

Follow Lindsey Tanner's medical editor on Twitter at @ LindseyTanner.