Cancer, like hypertension, diabetes, and arthritis, is considered a disease of aging. In fact, the American Society of Clinical Oncology names aging as the single largest risk factor for developing cancer. Age also increases our risk of other diseases and injury, which can influence how we respond to cancer and cancer treatments.
These factors—and more— must be considered when cancer treatment decisions are made to ensure our elderly loved ones receive the highest quality cancer care, both during and after treatment.
Recognizing the Challenges and Developing a Treatment Plan
Cancer in the elderly presents a host of concerns for patients and their families, not to mention a unique set of challenges for the healthcare teams that treat them. More specifically, the elderly often deal with issues that can make treating and managing cancer particularly trying. Among the complicating factors unique to the elderly are compromised balance, strength, and healing; bone loss, depression, cognitive losses, and dementia.
Pain continues to be one of the biggest challenges when dealing with seniors with cancer. Many times their condition, and the medications they take for their condition, can produce side effects when combined with pain medications. In fact, opioid drugs like oxycodone are often considered unsafe for the elderly.
Cancer treatment for elderly patients requires an approach that involves the patient, the patient’s family, care givers and members of their healthcare team, all of whom must work together to ensure the best quality of life possible, both during and after treatment.
For example, decisions on how to treat elderly people with cancer often depend more on their general health and expected quality of life than their actual age. This means physicians and cancer specialists, including oncologists and geriatric oncologists, often look at the social, emotional, and spiritual lives of their elderly cancer patients in order to structure a cancer treatment and recovery program best suited to patient needs and desires.
A cancer treatment plan for elderly patients usually begins with a comprehensive geriatric assessment (CGA), which takes into consideration a number of factors often unique to older patients, such as:
• Co-morbidity
• Functional dependence
• Polypharmacy
• Malnutrition
• Cognitive dysfunction
• Depression
The Assisted Living Facility Option
Assisted living facilities, more than ever, are offering a unique philosophy called “aging in place,” which allows residents to receive increasing levels of care without leaving their home or community. Assisted living facilities that cater to the concept of aging in place allow residents to stay in their communities for as long as they choose or need, from active retirement living to end-of-life hospice care and palliative care.
For elderly cancer patients, assisted living may provide much-needed monitoring and care during this difficult time in their life. Assisted living facilities often reduce the burden on families and provide them with peace of mind knowing that their loved one’s safety and health are being looked after by an interdisciplinary team that may not only include doctors and nurses, but social workers, psychologists, and physical and occupational therapists, as well.
Assisted living facilities are also the right choice when a patient’s condition cannot be properly managed at home. Some of the questions families should ask themselves when considering whether to let their loved one live at home or in an assisted living facility while undergoing and recovering from cancer care include:
• Can we meet our loved one’s physical and mental needs at home?
• Can we meet our loved one’s physical and mental needs at home if the condition gets worse?
• Are we willing/able to monitor our loved one’s medical equipment, medications, and health status?
• Are our loved one’s symptoms under control?
• Are we always available to provide care to our loved one?
• Is our loved one safe in the event of an emergency?
With many cancers, a patient’s needs change as the cancer progresses or as treatment progresses. Some seniors are able to safely remain at home during the early stages of cancer, but require extra care as their cancer progresses. The healthcare team and family should re-evaluate the needs of the patient on a regular basis so as to determine whether or not an assisted living facility may be able to offer more comprehensive care than they are receiving at home. Many times, the patient may also make the decision, after speaking with a member of the oncology or medical team, to enter an assisted living facility.
Many treatments for cancer can be completed at an assisted living facility, thereby eliminating or reducing the need to leave the facility to receive treatment. In addition to providing supportive care and tending to the patient’s health needs, an assisted living facility healthcare team can administer any number of cancer treatments, such as:
• Medication
• Intravenous (IV) chemotherapy
• IV antibiotics
• Subcutaneous injections
• Intramuscular injections
Cancer treatment and care at an assisted living facility ensures that:
• The cancer treatment plan is executed
• Treatments and medications are being given as prescribed
• The patient is being monitored for any side effects to treatments
• Pre-existing conditions and diseases are being managed
• Pain is being managed
• Emotional support is being provided
• The patient is eating and drinking
• The patient is receiving personal care and hygiene support
• There is collaboration and communication with the patient’s physician and oncologist
• The patient continues to receive care, including palliative care, as the cancer progresses