Dr MS Baliga, MIO Hospital

Mangaluru, Jan 15: Cancer has traditionally been known as an ailment affecting the elderly population and global reports indicate that More than 60% of patients with cancer are above the age 65 and that nearly 15% are above the age of 80. In India and the Mangaluru region, some of the most common cancers that affect the elderly are that of prostate, colorectal, lung, breast, bladder, pancreatic, kidney, and adult leukemia. Further, it is expected that as life expectancy increases, there will be an increase in the number of older individuals being afflicted by cancer. This will exert heavy pressure on the healthcare system that is already struggling to take care of patients with cancer and survivors.

Why does cancer risk increase with age?

As we grow, the cells in our body can get damaged by chance or due to exposure to cancer causing agents like cigarette smoke or UV rays from the sun. Sometimes this damage can be fixed by our body. But sometimes this damage builds up and can cause cells to grow and multiply more than usual, thus causing cancer. In the aged, the repair is slow and the damage builds up in the cells that might eventually lead to cancer. Further, when compared to youngsters, the immune system of the elderly that protects against infection is weak. This consequentially leads to increased chances of bacterial and viral infections. A weak immune system is not capable of protecting against cancer and because of this elderly people can have very aggressive forms of cancer.

Which cancers are common in the elderly people and their symptoms?

Studies from around the world and India have shown that there are few cancers which are more common in the elderly and the warning signs are as follows:

Bladder cancer – Elderly patients will see warning signs that include frequent urination, blood in urine, a distended bladder and a burning sensation when urinating.

Lung cancer – Elderly patients will see warning signs including chest pain caused by coughing, intense or ongoing coughing, breathing difficulty, chronic pneumonia, and coughing up blood.

Bone cancer – Elderly patients will find that the most common warning sign is pain. Swelling near a bone is also a symptom that needs to be checked by a doctor.

Colon cancer – Older patients may find that there are no warning signs during the early stages. Later stages of colon cancer in elderly adults may include symptoms such as blood in their stools, a change in bowel habits, vomiting, and stomach pain.

Breast cancer – Elderly patients will find that the most common warning signs are lumps in the breast tissue or underarm area, breast or nipple pain, breast swelling, nipple discharge, redness or thickening of breast skin.

Adult leukemia - The most common signs include bleeding, easy bruising, frequent infections, mouth ulcer, nosebleed, pallor, and red spots on the skin, shortness of breath, swollen lymph nodes, unintentional weight loss, or weakness.

Stomach/gastric cancer - Recognizing the symptoms early on is crucial but typically, stomach cancer is not detected until the later stages, decreasing the chance of survival. The most recognizable symptoms are weight loss or loss of appetite, blood in stools, stomach pain, nausea and/or vomiting and jaundice.

Kidney cancer (renal cell carcinoma) - The most common signs include blood in the urine (hematuria), low back pain on one side (not caused by injury), a mass (lump) on the side or lower back, unexplainable fatigue (tiredness), loss of appetite and weight loss not caused by dieting.

Fever that is not caused by an infection and that does not go away.

Prostate Cancer – Is very common in men over the age of 60. The most common symptoms of prostate cancer are blood in urine, erectile dysfunction, and pain in lower body (hips, lower back, etc), and problems in urinating or urinating too often.

Why medical treatment of elderly people with cancer is a challenge?

Cancer care of elderly is a medical challenge to any health-care system. This is mainly because in most cases the older people are having different health status. This is because in older people there is a decrease in the functional capacity of major organs like the liver, brain, heart and kidneys. To add to this the socioeconomic factors like limited income conditions, loss of spouse, bereavement, social isolation, lack of family support, loneliness, neglect by family members and elder abuse also contribute to the problem.

From a physiological perspective ageing is also associated with a decrease in gastrointestinal motility, blood flow, secretion of digestive enzymes and metabolic functions, which can result in a reduced drug absorption rate. Further many elderly people are already afflicted with multiple morbidities like diabetes, hypertension, chronic renal and lung function, dementia, Alzheimer’s and Parkinson’s which reduce the body’s abilities to cope with the treatment of cancer. Under these conditions the care of elderly requires special integration of an oncologic and geriatric approach.

Current status in the care of elderly people with cancer

In developed countries, over the past 20 years, the medical community has seen development of geriatric oncology units that focus on the care of older patients with cancer. However, a gap in knowledge about the safest and most effective cancer treatment for patients in this age group exits in India. This is primarily because the care for elderly requires concerted efforts by the healthcare workers from different branches like oncologists, geriatricians, endocrinologists, physicians, ophthalmologists, dentists, speech and hearing specialists, dieticians/nutritionists, physiotherapists, psychologists and nurses specialized in care of the elderly.

Dr Suresh Rao, the director of Mangalore Institute of Oncology (MIO) opines that geriatric oncology is still in its infancy in India and there are very few hospitals focusing on this. Care of the elderly with cancer requires a concerted and meticulous planning involving healthcare workers from different branches and specializations and that is followed at MIO. The treatment plans are developed in accordance with the evidence based care of the elderly patients with cancer recommended by the international geriatric care manuals and guidelines considering their socioeconomic, religious, nutritional, general health and above all social and family support system. At MIO, we have a good number of elderly people above the age of 80 and the results are indicative of the fact that the treatment regimens planned are very effective and well tolerated by these patients. He also said that in addition to this emphasis is also placed on rehabilitation and training of the family members to take care of the elderly cancer survivors with the help of support groups and that all these concerted efforts have helped in personalized and complete care of the elderly survivors.