Importance of palliative care amongst elderly cancer patients

by Dr. Chandrashekhar Prasad Singh, Medical Oncologist, HCG Abdur Razzaque Ansari Cancer Hospital, Ranchi

Aging gives rise to susceptible chronic health conditions like diabetes, heart disease, and even cancer which forms an integral part of devising a personal care and treatment plan for the elderly. Not only does it helps in reviewing the symptoms and chances of cancer growth, but also finds the best treatment that may suit the patient, considering:

●       The type and spread of cancer

●       Risks and benefits of all available treatment options

●       Any other medical condition that might cause issues during the treatment or increase the risk of side effects

●       How the treatment might affect the patient's physical and emotional wellbeing

Overall health and cancer treatment

Age is just one of the several factors considered by the cancer care team while developing a treatment plan. The ideal cancer treatment strategy is determined by the precise diagnosis, overall health, and any other medical condition that the patient might be suffering from. This may entail the medical team being acquainted with one’s:

●       Activity levels

●       Nutrition and eating habits

●       Health issues called co-existing conditions

●       Vision or hearing disabilities

●       Cognitive abilities

●       History of falls

Some cancer centres perform a geriatric assessment, which is commonly known as GA. Geriatric assessments are a method used in geriatric medicine to treat older adults. These examinations are utilized in a multidisciplinary approach to evaluate patients. This permits the doctor to be aware of everything that occurs with the patient. It is a medical consultation that considers the elements that are especially relevant in the cancer care management of older people.

Certain examinations typically involve an assessment of the person's functional capabilities; however, they might be one-dimensional and simple. A person's activity level and independence are more essential than their age, which can be assessed using a geriatric examination. It determines an individual’s true biological age. This can help anticipate patient’s life expectancy and the probability of side effects from therapies. If a person is depressed, has difficulty walking, or requires social help can be determined from a geriatric examination. In these circumstances, the overall quality of life of these individuals can be assisted and improved.

Palliative Care for older people and its benefits

Palliative care is an approach that improves the quality of life of patients and their families facing the problem of a life-threatening illness by preventing and relieving suffering through early detection, accurate assessment, and treatment of pain and other physical, psychosocial, and spiritual problems. The last period of an elderly person suffering from a characterized morbid malignancy extends to a partial phase of complicated treatment decisions, difficult symptom management, and manifold psycho-social problems, this is where palliative care comes in the form.  

In recent times geriatric palliative care has been pioneered multi-fold to provide the best possible hospice for elderly patients.

Some of the benefits of Geriatric Palliative Care are:

·         Prioritizing the patient's interests, goals, and decisions.

·         Encourages the patient and their family

·         Aids patients and families in comprehending treatment regimens

·         Enhances quality of life

·         Handles pain and symptoms.

·         It focuses on the body, mind, and soul.

·         Cuts down on needless hospital visits

Treatment options for older cancer patients

Older cancer patients suffer clinical as well as larger institutional challenges to effective therapy. They may receive less aggressive treatment. Auxiliary lymph node dissection, adjuvant radiation therapy, chemotherapy, or hormone therapy are less likely to be used in older patients suffering from breast cancer.

Based on their diagnosis, kind of cancer, and extent of illness, older adults tend to tolerate and respond well to cancer therapy. Elderly patients who have a life expectancy of more than 5 years benefit from adjuvant therapy. For some patients, radiation therapy with a short treatment time and low tissue toxicity appears to be beneficial. Patients over the age of 65 who are in good health may tolerate molecular-targeted therapies alone or in combination with chemotherapy.

Patients and families must visit palliative care centers, where they can be aided with decisions, and receive support, and communication between doctors and patients and families is encouraged so that goals of care can be evaluated. Cancer treatment has the best success rate when detected early. Hence, in case of any warning signs, it is advised to visit a doctor.