1. Senior Adult Oncology

2. Overview  Cancer is the leading cause of death for those 60-79 years  60% of all cancers occur in patients who are 65 years or older  Older individuals are more prone to develop cancer due to physiological changes associated with aging

3. Older Adults Older patients can be classified into three categories:  Young Old: 65-75 years  Old: 76-85 years  Oldest Old: over 85 years

4. Age Distribution of U.S. Population, 1980, 1990, and 2005 Data source: The Bureau of the Census Year 1980Year 1990Year 2005 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

5. Frailty Decreased reserve and resistance to stressors Frail patients have an increased risk of complications from cancer treatments Risk for falling, disability, hospitalization, and death

6. Fraility Criteria  Unintentional weight loss (10 lbs or more in past year)  Self reported exhaustion  Weakness  Slow walking speed  Low physical activity

7. Geriatric Syndromes Malnutrition Malnutrition Polypharmacy Polypharmacy Lack of Social Support Lack of Social Support Depression Depression Dementia Dementia Fall Risk Fall Risk

8. Falls  One of the most common geriatric syndromes  30-40% of adults older than 65 years fall each year  Risk factors: muscle weakness and impairments in gait, vision, cognition, and ADLs

9. Activities of Daily Living (ADLs) Able to bathe self Able to bathe self Able to dress self Able to dress self Able to toilet self Able to toilet self Control over bowel & bladder Control over bowel & bladder Able to transfer self Able to transfer self Able to feed self Able to feed self

10. Instrumental Activities of Daily Living (IADLs)  Use the telephone  Get to places beyond walking distance  Grocery shop  Prepare meals  Housework  Laundry  Take medications  Manage money

11. Percent of Medicare Beneficiaries Reporting Difficulty with IADLs or ADLs by Age, 2004 Data Source: Medicare Current Beneficiary Survey Percent (%)

12. Percent of Persons Age 65 and Over (age-adjusted) Reporting Selected Chronic Conditions by Sex, 2004-2005 Data Source: National Health Interview Survey Percent (%)

13. Years of Education Among Persons Age 65 and Over (age-adjusted) by Sex and Race/Ethnicity, 2006 Data source: Current Population Survey Percent (%) Male Female

14. Cancer Treatment Benefits:  Prolonged survival  Maintenance and improvement of quality of life and function  Palliation of symptoms

15. Cancer Treatments Risks:  Complications of surgery, radiation, and/or chemotherapy  Affects on cognition, function, balance, vision, hearing, continence, and mood

16. Treatment Decisions  Life Expectancy  Aggressiveness of Disease  Functional Abilities  Comorbidities  Patient Goals  Social Resources  Tolerance of Treatment

17. Treatment Decisions  Advanced age alone should not preclude the use of effective cancer treatment  Older patients with good performance status are able to tolerate most forms of treatments  Treatment that diminishes quality of life with no significant survival benefit should be avoided