Why Cancer in Older Patients Should Be Treated Differently

Shared decision making in cancer treatments
Patient Power - July 2023

If you or a loved one is among the many older individuals with cancer, you were on the minds of a group of doctors at a session entitled “Shared Decision-Making for Older Adults with Cancer Using Available Treatment Tools,” at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2-6 in Chicago and virtually. This moderated discussion reviewed research and tools available to help inform treatment decisions in older patients.

Daniel Richardson, MD, MSc, MA, of the UNC Lineberger Comprehensive Cancer Center moderated the conversation between providers of different specialties. These included geriatrician Clark DuMontier, MD, MPH, of Brigham & Women’s Hospital; geriatric oncologist Kah Poh Loh, MS, MBBCh, of the James P. Wilmot Cancer Institute; and medical oncologist Melisa Wong, MD, of the University of California, San Francisco.

The panel addressed a difficult question: With older adults under-represented in most clinical trials, how can doctors best recommend cancer treatments to these patients?

For this population, the availability of social support and the level of functional and cognitive abilities can make some treatment options better or worse – considerations that usually aren’t as important for the younger patients who fill most trials. To fill this gap, panelists encouraged doctors to use a geriatric assessment, a comprehensive, holistic approach to evaluate an older person’s health, to help base treatment decisions on the patient’s priorities and health. They also stressed the need for clinicians to elicit and for patients and their families to communicate their goals and concerns.

“[The geriatric assessment] rises to the challenge of avoiding both under-treatment and over-treatment of older patients, where we don’t have clear evidence on the safety and effectiveness of regimens that were tested on younger trial populations,” Dr. DuMontier said. “If [a patient is] frail and they have multiple aging-related vulnerabilities that may not be helped by the cancer treatment – and might even be exacerbated by an intensive regimen – then they’re at higher risk of toxicity. The harms of the treatment might outweigh the benefits.”

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