Trevor A. Jolly MBBS Cancer and Older Adults: Care and Treatment November 19, 2015 Why Worry About Cancer As We Get Older

The Tsunami of Cancer and Aging

The US Population is Aging

Population Age 65+ in North Carolina, 2000 Mean = 12.0%. Range = 6.3% to 23.6%

Population Age 65+ in North Carolina, 2030* Mean = 17.7%. Range = 10.5% to 35.2% *Based on July 2006 population projections

Cellular Water 2 Kidney Blood Flow 3 Maximum Breathing Capacity 4 Nerve Conduction Velocity 5 Heart Output Age (years) Percent Reserve Capacity Remaining Organ Reserve and Age Baker and Martin, Geriatric Medicine, 1996

Comorbidity and Age Prevalence of various comorbid ailments by severity across the age spectrum. Piccirillo et al. Crit Rev Oncol Hematol Aug;67(2): DementiaHeart Failure Prior Cancer HIV/AIDS DiabetesHypertension

Erikson, C. et al. J Oncol Pract; 3: Age-specific cancer incidence rates/100,000 year 2000 The Median Age of a Cancer Diagnosis in US is 67 ! Cancer incidence and Age

Cancer Mortality and Age Smith B D et al. JCO 2011;29:

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 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

Oncologist –General –Chronological age –History and Physical Examination –Functional Status –Karnofsky performance status –Eastern Cooperative Oncology (ECOG) Group performance status

Age

Tumor Characteristics Performance status Age Function deficits Comorbidities Nutritional deficits Psychosocial dysfunction Polypharmacy Falls Cognitive impairment Social Support Organ function The Geriatric Oncology Iceberg

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 DOMAINASSESSMENT MEASURE Health ProfessionalSelf Reported Functional Status Timed Up and Go KPS- Physician Rated Activities of Daily Living (ADL) Instrumental Activities of Daily Living Karnofsky Self Reported No. of Falls in the last 6 months Co-morbidity Number /Type of Comorbid Conditions No. of Medications Vision and Hearing Assessment Cognition Blessed Orientation Memory-Concentration Psychologic Mental Health Index-17 Social Social Activity Limitation Measure (MOS) Social Support Survey (MOS) NutritionBMI Unintentional Weight Loss 6 mths 10 minutes minutes

Deficits in Normal PS Patients Frequency (%) Professionally-Assessed KPS Patient- Rated KPS < Total <50 8 (0.8%) 3 (0.3%) 8 (0.8%)19 (2%) (1%)38 (4%)89 (9%)137 (14%) (0.4%)28 (3%)796 (81%)828 (84%) Total22 (2%)69 (7%)893 (91%)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!