Older adults and elderly individuals comprise more than 50% of cancer patients in the U.S. and as a group, are the most common recipients of chemotherapy. A large segment of American adults are already sixty-five years or older, and their life expectancy is at least fifteen years more. Ideally, they will remain functionally independent during this time. By comparison, a seventy-five year-old has an average life expectancy of ten years, while an eighty-five-year-old has an average life expectancy of six years.
Health care professionals use a comprehensive geriatric assessment to help determine a cancer patient’s prognosis and calculate life expectancy as it relates to the diagnosis. The following is an overview of the factors that are considered in the geriatric assessment:
1. Functional Status
The geriatric assessment includes measurements of physical performance such as Time Up and Go, in which the patient is required to get up from a chair, walk eight feet and return to the chair. Not all patients are evaluable, but there are nationally recognized scales of level of functioning (e.g., Karnofsky and the ECOG scales) through which a physical assessment of functioning can be summarized and understood by all health care workers.
A general assessment of frailty is also very helpful, as it prompts health care professionals to advise the patient on how to prevent falls and improve functional living. The geriatric assessment evaluates whether the patient can independently perform the activities of daily living, as there is often a need for home care or institutional care. Treatment toxicity and recovery time are also important factors in determining the patient’s functional status.
2. Comorbidities
This step entails listing any of the patient’s medical problems, such as diseases of the heart, lung or kidney, which could present a comorbidity. In addition, the health care team evaluates its ability to control diabetes and other diseases caused by the metabolic syndrome. This is particularly important, since poor control of these other diseases can reverse any benefit seen by cancer therapy. This is especially true with diabetes and obesity, both of which have been shown to shorten the survival for breast cancer and colon cancer.
3. Nutritional Status
Cancer treatments can be extremely rigorous on the body, particularly when one’s immune system is already compromised. In order to prepare the body for cancer treatment, the patient must follow sound nutritional patterns and lead a balanced nutritional life. Health care professionals evaluate the patient’s nutritional status as a part of the comprehensive geriatric assessment.
Read the The All-in-1 Pocket Guide to Healthy Choices for more information on nutrition.
4. Social Support
A personal network of support is key for anyone experiencing a major health event. This is particularly true for older adults with cancer who are undergoing treatment. This step identifies the patient’s medical team, family and friends.
5. Cognitive Status
The patient’s cognitive status is an essential part of the geriatric assessment. Health care professionals test the patient’s memory, clarity of thought (i.e., cognition) and also perform tests to evaluate oriented memory and overall mental status.
6. Depression & Psychological Health
Oftentimes with age come psychological problems. A geriatric assessment includes an evaluation of the senior’s level of depression and psychological health. One common problem is delirium, which is characterized by many daily fluctuations in one’s level of attention and arousal. This sometimes manifests in agitation of sleepiness.
Read more articles on Senior Depression, including resources and tools to help alleviate it.
7. Medications
The geriatric assessment also reviews the patient’s medications since many of these, including vitamins and other supplements, can interfere with cancer treatment and overall quality of life.
Using this comprehensive approach helps health care professionals in determining and calculating their cancer patients’ life expectancy. For the most part, the length of survival will depend on the type of cancer, as well as the stage of the disease, the types of therapy the patient undergoes and the patient’s response to therapy. However, it’s not solely about the length of survival; it’s the quality of life that will be markedly improved by attention to the above factors. The ultimate goal is to streamline the treatments necessary to improve one’s function and longevity.