America is growing older. As reported in the 2000 US Census, 12 percent of the population is 65 or older, a number that is expected to grow to 20 percent by the year 2050. By 2011, the first wave of baby boomers -- those Americans born between 1946 and 1965 -- will turn 65. Thanks to advances in medicine and an increased focus on nutrition and exercise, these individuals are expected to live longer lives than their predecessors. This good news is tempered by the fact that the incidence of cancer rises exponentially as the population ages. Memorial Sloan-Kettering is working at the forefront of the effort to prepare for this new reality.
Discrepancies in Care
According to the National Cancer Institute and its Surveillance, Epidemiology, and End Results (SEER) analysis, individuals 65 and older account for 60 percent of all newly diagnosed cancers and 70 percent of cancer deaths in the US. Although older individuals make up the majority of cancer patients, a number of studies have shown that patients aged 75 and older often receive less rigorous diagnosis and treatment than younger patients -- even when a number of older patients can tolerate surgery, chemotherapy, and radiation therapy as well as their younger counterparts. While frailty and the presence of other co-existing diseases in older cancer patients may account for many of these treatment decisions, others may have less valid explanations.
One measure of this issue is reflected in the age breakdown of clinical trial participants. Designed to help determine the safety and efficacy of investigational approaches, clinical trials provide participating patients with access to promising new therapies. In a study published in the November 2004 Journal of Clinical Oncology, the study's authors discovered that only 36 percent of patients aged 65 and older participate in clinical trials for cancer drugs. If elderly patients do not participate in clinical trials in adequate numbers, these patients may not know whether these treatments are safe and effective for them.
Multidisciplinary Approach to Geriatric Care
To begin the process of providing these patients with the full spectrum of care, Memorial Sloan-Kettering -- with the support of an institutional grant from the National Institutes of Health and funding from the Joachim Silbermann Family -- has developed a geriatric research program and a clinical initiative known as the Joachim Silbermann Family Program in Aging and Cancer. These programs encompass the following geriatric-focussed topics: treatment effectiveness and tolerance; psychosocial issues and medical effects; patterns of care; and the biology of aging and cancer.
Seeking to tailor care to this age set, Memorial Sloan-Kettering has put together a multidisciplinary geriatric team, which includes clinical nurse specialists, social workers, nutritionists, psychiatrists, as well as members of the Pain and Palliative Care Department and Integrative Medicine Service. This team provides programs and care specifically focussed on the needs of elderly cancer patients.
"Memorial Sloan-Kettering is committed to providing these patients with the treatment, facilities, and support they require and deserve," says Stuart M. Lichtman, MD, leader of the Geriatric Clinical Program at the Center.
Social Work, Pain & Palliative Care, and Psychiatry
The Center's efforts begin with a 65+ Social Work Program, which provides psychosocial assessment and intervention to the high-risk, older cancer patient, as well as education and information for patients, caregivers, staff, and community agencies on issues related to aging and cancer.
The Older Adult Pain and Palliative Care Service helps elderly patients with the management of their physical symptoms, and with their psychosocial, spiritual, and end-of-life care. And the Center's Geriatric Psychiatry Program, which has conducted over 2,500 patient visits since its inception in 2005, offers psychiatric consultation, medication management, psychotherapy, follow-up care, and a number of research studies.
"When cancer occurs in the older adult, it strikes at the time when physical, psychological, and social losses are taking place," says Jimmie Holland, MD, who holds the Wayne E. Chapman Chair in Psychiatric Oncology at Memorial Sloan-Kettering. These losses often include diminished sight, hearing, and mobility. At the same time, the loss of family members and friends begins to occur more frequently, and retirement may change an individual's financial security. "We have begun to focus on these combined medical and psychological issues in the Geriatric Psychiatry Program," notes Dr. Holland. "In the program, we are interested not only in providing help during treatment but also in addressing our patients' continuing needs as survivors."
Nutrition, Rehabilitation & Music Therapy
The nutrition component of the Geriatric Program includes initial nutrition assessments, nutrition education, and follow-up assessments. The Rehabilitation Department has also joined the Geriatric Program. Using both physical and occupational therapy techniques, members of the Rehabilitation Department seek to improve the efficiency of the patient discharge process, to decrease the number and severity of common complications in the elderly cancer patient, and to help maintain the independence and enhance the quality of life in all older patients. Finally, the Music Therapy Program of the Center's Integrative Medicine Service is also involved in using music to effect positive emotional, physical, and spiritual changes in older patients.
Referring to the impending surge in the number of elderly Americans, Dr. Lichtman notes that much more work needs to be done to prepare for the increase in the total number of patients with cancer that will accompany this "graying" of America. "Memorial Sloan-Kettering is committed to staying ahead of the challenge," he says, "creating the programs and services now to meet the many demands that await us."
