FACET - European Journal of Cancer Care
December 2004
slides available at: www.blackwellpublishing.com/journals/ecc
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FACET - European Journal of Cancer Care
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slides available at: www.blackwellpublishing.com/journals/ecc
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  • Notes
    As the population continues to age, especially those in the old (75-84) and very old (85 years or more) age groups, addressing the implications for cancer burden and improvements in the management of cancer for this age group become more pressing.
    The increase in an ageing population means that despite better treatment and detection of cancer, the incidence of cancer related diagnosis will continue to rise.
    It will require healthcare professionals to challenge their own prejudices and views on ageing and to look beyond chronological ageing to the impact of biological ageing on individual older people. Biological ageing is not a linear process “it varies not only among individuals but within different systems of the same person” ... “Aging is a highly individualised process, demonstrated by the differences between persons of similar age” (Eliopoulos 1997, p45).
  • Notes
    The strong link between age and cancer would indicate that, oncologists need to develop a greater awareness of the impact of biological ageing on the cancer management of older people and gerontologists need to be more alert to the signs and symptoms of cancer in this age group, if their needs are to be met effectively (Repetto & Balducci, 2002).
    Present research suggests that there are many issues which still need to be addressed before cancer outcomes are optimal for this ageing population.
  • Notes
    A number of reasons have been identified for why cancer is more prevalent in older people.
    Longer exposure to carcinogens including smoking which is on the decline in older men but still rising with older women.
    The development of cancer needs time and a susceptible host and therefore age increases the likelihood that cancer will develop.
    Alterations in the immune function and DNA repair efficiency may increase susceptibility to malignancy. Decreased recognition of a mutant cell, poor immune surveillance and increased mutation (Vardaxis, 1995).
    Possible changes in gene expression during ageing may lead to increased risk of cancer (Cunningham, 1996) although this hypothesis is still not universally accepted.
    Repetto and Balducci (2002) describe research in which some tissues from rodents become more susceptible to environmental carcinogens over time and they go on to suggest this could be similar in humans.
  • Notes
    It is important to draw this distinction because in the past, studies of ageing changes have often been interlinked with pathologic disease conditions and this has led to a false association of age with illness or disease. It is sometimes difficult to separate the two, making it essential that any assessment explores the changes that occur without immediately categorising them as pathologic or normal.
    Two interesting approaches to identifying age related changes are proposed by Sloane (1992) and Lakatta (1995) cited in (Ebersole & Hess, 1998) and could prove helpful to physicians and researchers when it comes to making decisions about appropriate treatments for cancer in this age group.
    Sloane (1992) has proposed the ‘Rule of Thirds’ in which he suggests that one third of ageing changes occur as a result of functional decline due to disease, a third as a result of inactivity and a third caused by ageing itself.
  • Notes
    Lakatta (1995), cited in Ebersole & Hess (1998, p85), places ageing into two categories “usual (average) ageing and successful (pure) ageing. Usual ageing refers to the combined effects of the ageing process, disease and adverse environmental and lifestyle factors. Successful ageing refers to the changes due solely to the ageing process uncomplicated by damage from environment lifestyle, or disease”.
    The previous points remind healthcare practitioners of the need to consider the individuality of the older person and to challenge the complex concept of frailty which often dominate clinical decisions in cancer management. As Repetto & Balducci (2002, p295) suggest “it would be of great benefit to both oncologists and geriatricians if a consensus was reached” on what the term implies.
    You might like to reflect on an assessment you have completed recently and identify how objective this was or how much of it relied on established perceptions and ideas about ageing.
  • Notes
    As people age their physiology and metabolism change in ways which may impact on the bodies’ ability to respond effectively to the stressors imposed by cancer and other diseases. Age may be associated with loss of cardiac muscle fibres as a result of ischaemic or degenerative changes and loss of cardiac function which falls by about 1% from the age of 25 years until 80 years.
    Similarly in the kidneys there is a decline in glomerular filtration rate and reduced ability to concentrate urine making drug excretion more problematic. Changes in liver function are less predictable and the ability of the liver to metabolise drugs may be little effected by age. However there is a decrease in gastric acid production and functional absorption which, together with increasing use of antacids, may significantly alter the absorption and metabolism of oral cancer medication.
  • Notes
    Reduction in the reserve capacity of the bone marrow beyond the age of seventy may reduce its ability to respond to stresses such as blood loss or infection or to sustain or recover adequate numbers of circulating cells after chemotherapy.
    Reduced tissue repair, particularly of skin and mucosal tissue will also affect the ability to tolerate radiotherapy.
    Another consideration is the age related changes to the eyes and ears which might affect the older person’s ability to communicate optimally with healthcare professionals (Ebersole & Hess, 1998; Eliopoulos, 1997 and Posner, 1995).
    These changes will need to be carefully considered when undertaking an assessment and deciding on the best cancer treatment for an individual older person.
  • Notes
    Ageism plays a part in the treatment of older cancer patients as they are often denied access to aggressive treatments. Health professionals make an assumption about the older person not being able to cope with aggressive forms of treatment despite evidence to the contrary. Studies of outcomes from surgery, chemotherapy and radiotherapy suggest that older people are able to tolerate these therapies well and gain as much curative or palliative benefit from the treatment as their younger counterparts (Patel & Zenilman, 2001; Matsushita et al, 2002; Turner et al, 1999).
    Although 12% of all newly diagnosed breast cancer patients are 80 years and over, the evidence confirms they do not always receive optimum treatment. A study by Bouchardy et al (2003) suggests they receive inconsistent treatment which differs from that of younger women. As older women are often excluded from clinical trials this results in treatments being based on subjective criteria such as consultant preference or uncertainties about the natural progression of the disease rather than, as for younger people, clinical evidence protocols.
  • Notes
    Corner (cited in Cooley & Coventry 2003) suggests that although not all treatments are appropriate for older people, there needs to be greater emphasis and consideration given to physiological age and performance status rather than of the person’s chronological age.
    The National Service Framework has implications for cancer treatment in older people and requires a more proactive approach to inclusion of older people in clinical trials and better use of existing research to inform cancer protocols.
    Healthcare professionals need to challenge their own prejudices and views on ageing and to look beyond chronological ageing to the impact of biological ageing on individual older people. Biological ageing is not a linear process “it varies not only among individuals but within different systems of the same person” ... “Aging is a highly individualised process, demonstrated by the differences between persons of similar ages” (Eliopoulos 1997, p45).
  • Notes
    Researchers suggest that optimum cancer treatment in older women remains a complex issue for clinicians and older people alike. One reason for this confusion is the fact that decisions are often made based on misconceptions, including ideas that older people have less aggressive forms of the disease; limited life expectancy related to comorbid conditions; and in relation to other causes of death in older people, cancer mortality remains marginal (Bouchardy et al, 2003).
    Similar evidence suggests that this is not specific to breast cancer but is similar with the treatment of other cancer types.
    A number of studies suggest that the treatment options for older people are reduced partly because they are excluded from many of the clinical trials which have strict exclusion criteria around comorbidity. This means that outcomes from new treatments are unlikely to be tested for their efficacy with older people, the group, they are most likely to be used with (Schmitt, 2004; Westin & Longo, 2004; Cooley & Coventry, 2003; and Rinebart Ayres, 2004).
  • Notes
    The argument for reviewing clinical trial criteria is eloquently made by Lewis et al (2003) when they suggest that “Without a better understanding of the scientific justification for these exclusions, more trials focused on older people, or changes in study design or requirements, many cancer trials may fail to provide the best possible evidence for treating older people with cancer” (Lewis et al 2003, p1388).
    In a recent study by Yancik et al (2001) they found that older American women with breast cancer were receiving less aggressive treatment including fewer axillary node dissections, breast conserving surgery or radiotherapy in comparison to younger women with breast cancer. If the women presented with pre-existing diseases such as diabetes, hypertension, stroke, gastro-intestinal or other health related problems this seemed to be an influencing factor in less aggressive forms of treatment being prescribed.
  • Notes
    Problems in early detection of cancer include older people not presenting till late in the disease process. This is in part because there is a tendency for the older person and their general practitioner to dismiss the symptoms as age related without investigating further. In breast cancer, this differs in countries where there is routine mammography screening. Recent studies have found that mammography screening, in those over 65 years, has resulted in better detection of early stage cancers than in the 50 to 64 year age group age (Lichtman & Zaheer,1996).
    Signs and symptoms of cancer can be vague and non specific, especially in the older age group which makes it harder for diagnosis.
    Older people are on average likely to present with at least three comorbidities as well as cancer.
    To address the issues of late reporting of cancer symptoms there needs to be an effective health promotion and awareness raising campaign amongst older people and healthcare practitioners aimed at promoting awareness of, need for and value of, early detection and treatment of cancer.
  • Notes
    Breast
    Screening for cancer disease in older people has had a positive impact on early detection of the disease. However there is still an ongoing debate as to the cost effectiveness and benefits of screening older people and to what age screening should be available.
    The American Cancer Society in 2003 revised its breast screening guidelines and included a recommendation that older women should continue to be screened if life expectancy is felt to exceed five years (Rinebart Ayres, 2004). Evidence from some USA studies suggest that many older women, especially those in minority and low socio-economic groups are not taking up the opportunity for regular mammography screening. One survey in the USA found 47% of women between 50 – 74 years had never had a mammogram and of this group, 42% of black women and 28% of white women reported their doctor had never suggested mammography screening (Lichtman & Zaheer, 1996).
  • Notes
    Cervical
    Between 1988 and 1997 there has been a 42% drop in incidence of cervical cancer in England and Wales which correlates with the NHS cervical screening programme.
    Prostate Screening
    There is some controversy around testing for Prostate Specific Antigen (PSA) as its effectiveness is called into question in regards to its accuracy in identifying prostate cancer. In older people, especially those over 75 years, a slow growing tumour may not be the cause of death and therefore require minimal treatment. PSA testing fails to differentiate between slow and fast growing prostate cancers and therefore remains a crude instrument in diagnosis
    The National Cancer Plan (DoH) 2000 states “PSA testing to detect prostate cancer will be made available, supported by information about the risks and benefits, to empower men to make their own choices” (DoH, 2000, p10).
  • Notes
    Colorectal Cancer
    It has been suggested that screening should be introduced for all people aged 50 years to 69 years.
    Controversy around the feasibility of bowel screening was reinforced by findings, from the Gut study led by the Royal Free Hospital. However it is predicted that mortality rate from bowel cancer could decrease by 15% if national screening was introduced saving approximately 2,500 lives per year.
    In breast, cervical, PSA testing and bowel cancer, there is a cut off age for routine screening and a reliance on older people outside that age to request screening if they feel they need it. It is questionable that older people will have the knowledge and feel empowered to request routine screening and will only do so once the cancer is advanced. What remain unclear are the criteria on which age barriers are put on routine screening programmes.
  • Notes
    Assessment of older people is a complex process involving the older person and all relevant health and social care professionals in a partnership which values all their views and expertise.
    A good biographical assessment values the older person and ensures they are seen holistically and not just from the perspective of the presenting problem (Gearing & Coleman, 1996). This should help address the rather limited view of old age that seems to underpin treatment decisions in cancer services for many older people.
    There are many assessment tools designed to help with the process but any tool to be comprehensive, needs to address not only physiological and functional needs but also the psychosocial, cultural and spiritual needs of the older person.
    A comprehensive assessment is a fundamental pre-requisite to any health care interaction and forms the bedrock for any clinical decision regarding treatment and care for the older person. There is strong evidence that it improves both survival rates and physical and cognitive functioning (Robinson & Turnock, 1998).
  • Notes
    In the United Kingdom the National Service Framework for Older People (2001) provides a ten year strategy to improve services in health and social care for older people. It has eight standards all designed to provide older people with choice and quality in the care they receive.
    Each standard has a number of targets to be achieved and in standard two the single assessment is one such target. This has had the effect of raising assessment on all health and social care agenda’s and ensuring that they are all working together to improve the process and putting older people at its centre.
    If you are interested in looking at the National Service Framework for Older People (NSF) and The Single Assessment Process (SAP) you can access them by typing the following website address: http://www.nelh.nhs.uk/nsf/older_people/default.htm
  • Notes
    Information in these four domains is essential if a holistic assessment is to be achieved. However assessment relies on the skilled approach of the assessor in empowering the older person to engage in the process. Assessment data relies on the accuracy of the information collected to inform clinical decision-making. Limited data in one or more domains may skew the assessment and lead to poor treatment outcomes.
    A good assessor will shed their ‘professional’ perspective and have an open mind, prepare to learn from the older person and value their expertise and opinions, even if these run counter to the assessors own values (Nolan & Caldock, 1996).
  • Notes
    “Currently the most reliable and best validated method for assessing older people with cancer is a multidimensional appraisal, which includes functional states, comorbidity, cognition, emotional status, social support, nutrition and medication” (Repetto & Balducci, 2002, p294)
    Baseline functional assessment needs to consider sensory impairment; mobility and ability to perform Activities of Daily Living. It also needs to consider the impact of cancer on functional state which includes lethargy and fatigue; nutritional deficits and muscle weakness.
    Assessment in an older person cannot just focus on the cancer but must also consider the risks from comorbidity and their impact on diagnosis treatment and life expectancy in the older person with cancer.
  • Notes
    Distress caused by nature of the illness, if not identified, can lead to unresolved conflict and psychological pain.
    Any diagnosis of cancer will have a major impact on the older person’s wellbeing. How this is addressed will be influenced by a lifetime of coping with life’s stressors. Any assessment needs to include an understanding of the older person’s psychological strengths and weaknesses so that preventative strategies can be put into place.
    The outcome of any cancer treatment is to improve quality of life for the older person, however, many quality of life indicators fail to address the psychosocial aspects of quality.
    Empowerment and choice have been found to be critical indicators in maintaining psychological health in older people and enabling them to continue to exercise choice over their life. Removal of choice has a negative impact on psychological functioning (Thomé et al, 2003).
  • Notes
    Older people need to be offered the same choices as younger people when it comes to counselling and psychological support.
    Dementia or cognitive decline in old age may cause additional difficulties and this need’s to be explored in any assessment.
    Cancer can often have a major impact on the older person’s sexuality and self image and information and support to deal with this is as important as it is for younger people. Research suggests that in the area of breast cancer in particular these considerations are not considered in management modalities (Girotto et al, 2003).
    A diagnosis of cancer is life changing for the older person and also changes the dynamics of relationships they may have with family and carers. This might have a negative effect on the older person’s quality of life, and the family as well as the older person may need access to counselling and advice.
  • Notes
    Baxter (1995) cited in Fee et al (1999) found that older people tended to include social factors such as going out and seeing others in their definition of ‘good health’ and conversely, loneliness and social isolation were felt to be indicators of ‘poor health’.
    In the same study, a woman with breast cancer felt healthy and contented with life “..in the long term, her medical condition had not affected her ability to look after herself and her home, and she was able to enjoy a full and active social life” (Fee et al, 1999, p11). Assessment and management need to identify any concerns the person may have about their ability to maintain their existing social interactions and lifestyle.
    Psychological support and home care support is essential to ensure all older people with cancer are able to optimise their quality of life both for active and palliative management.
    Cancer may impose additional financial burdens on the older person and their family and this will need to be addressed.
  • Notes
    Considering huge prognostic differences among cancer sites and stages, there needs to be more specific research targeted at older people with different cancers.
    Normal ageing changes may affect the older person’s ability to respond optimally to treatment, especially chemotherapy. Add to this the greater risk of chronic and multiple diseases the older person may have and it makes it more likely that current treatments may be less effective and result in more side effects. It is essential that older people are included in clinical trials to optimise best practice.
    Older people have as much right to information about their diagnosis and its likely outcome as any adult. Once the diagnosis is shared, information needs to be clear and appropriate in helping the older person make a choice about treatment options. Once the decision has been made then healthcare professionals need to value that choice and support the older person through their cancer journey (Thomé et al, 2003).
  • Footnotes
    1Denise Forte (RGN, RSCN, Dip. Appl. Science (Nursing), PGCEA, MSc in Gerontology), Principal Lecturer - Adult Nursing and Gerontology, Faculty of Health and Social Care Sciences, Kingston University and St George’s Hospital Medical School, Blackshaw Road, Tooting, London SW17 0QT.
    2Rebecca McGregor (BSc Hons Physiotherapy, MCSP), Clinical Specialist Physiotherapist for Older People at the time of writing this article, St George’s Hospital NHS Trust. Currently, Senior Physiotherapist, Palliative Care, Earl Mountbatten Hospice, Newport, Isle of Wight. 
    Correspondence address: dforte@hscs.sghms.ac.uk
  • FACET - European Journal of Cancer Care

    1. 1. FACET - European Journal of Cancer Care December 2004 slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners Forte, D.1 McGregor, R.2 SlideOne *Click on “View”; “Notes Page” for explanatory notes Population ageing in United Kingdom • Currently over one fifth of the population is over 60 years • By 2025 those over 80 years will increase by almost 50% • By 2025 those over ninety will have doubled • Estimated percentage of older people 65 years or more in population in 2004 is 15%
    2. 2. FACET - European Journal of Cancer Care December 2004 slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued) SlideTwo *Click on “View”; “Notes Page” for explanatory notes Incidence of cancer in older people • Cancer generally increases with age • Incidence of most malignant cancers increase with age up to 85 years • Decline in these cancers after 95 years • 12% of newly diagnosed breast cancer patients are 80 years or more
    3. 3. FACET - European Journal of Cancer Care December 2004 slides available at: www.blackwellpublishing.com/journals/ecc SlideThree *Click on “View”; “Notes Page” for explanatory notes Link between cancer and old age The link between old age and cancer is the result of three main factors according to Repetto & Balducci (2002) • Substantial length of time required for carcinogenesis • The occurrence of age related molecular changes that mimic carcinogenesis • Changes in bodily environment that favour cancer progression Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    4. 4. FACET - European Journal of Cancer Care December 2004 slides available at: www.blackwellpublishing.com/journals/ecc SlideFour *Click on “View”; “Notes Page” for explanatory notes What do we mean by ageing? “The universality of ageing places it outside the realm of pathologic study. The changes that occur are normal for all people but take place at different rates and depend on accompanying circumstances in an individual’s life”. (Ebersole & Hess 1998, p85) Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    5. 5. FACET - European Journal of Cancer Care December 2004 slides available at: www.blackwellpublishing.com/journals/ecc SlideFive *Click on “View”; “Notes Page” for explanatory notes Challenges of chronological ageing versus biological ageing • Ageing varies not only among individuals but within different systems of the same person” (Eliopoulos 1997 p45) • “Aging is a highly individualised process, demonstrated by the differences between persons of similar ages” (Eliopoulos 1997 p45) • Chronological ageing is an indicator of the number of years lived but is only a crude indicator for ageing Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    6. 6. FACET - European Journal of Cancer Care December 2004 SlideSix *Click on “View”; “Notes Page” for explanatory notes Loss of function in old age and implications for cancer (1) • Nervous system 10% • Basal metabolic rate 15% • Cardiovascular system 30% • Pulmonary system 50% • Renal system 30% slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    7. 7. FACET - European Journal of Cancer Care December 2004 SlideSeven *Click on “View”; “Notes Page” for explanatory notes Loss of function in old age and implications for cancer (2) • Bone marrow • Reduced tissue repair • Changes to sensory system slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    8. 8. FACET - European Journal of Cancer Care December 2004 SlideEight *Click on “View”; “Notes Page” for explanatory notes Are cancer services inherently ageist? • Often older people receive less screening for cancer • They are less likely to be referred to a main cancer centre • Once diagnosed, often receive less aggressive treatment leading to an increase in mortality from the cancer rather than comorbidities • Problems related to early detection of cancer slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    9. 9. FACET - European Journal of Cancer Care December 2004 SlideNine *Click on “View”; “Notes Page” for explanatory notes The National Service Framework for Older People (DoH, 2001) has as its first standard, the need to root out age discrimination in the health service. It states that: “NHS services will be provided; regardless of age, on the basis of clinical needs alone” slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    10. 10. FACET - European Journal of Cancer Care December 2004 SlideTen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued) Older people and access to clinical trials (1) • Researchers indicate that for all cancers, older people are under- represented in clinical trials. This is due to • The strict exclusion criteria built into many research protocols
    11. 11. FACET - European Journal of Cancer Care December 2004 SlideEleven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Older people and access to clinical trials (2) • Older people often present with comorbidity which pre dates the diagnosis of cancer and which many clinicians feel makes the older person too vulnerable for the more aggressive forms of treatment • Misconceptions about ageing and cancer may have a negative effect when it comes to influencing clinical decisions about treatment Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    12. 12. FACET - European Journal of Cancer Care December 2004 SlideTwelve *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued) Problems related to early detection and access to treatment • Effects of ageism on early presentation of symptoms • Signs and symptoms of cancer can be vague and non specific • Clinical presentation may be slow to develop and be masked by other age related physical changes and comorbidities • Importance of raising awareness of early detection in older people. • Need for comprehensive assessment by multiprofessional team
    13. 13. FACET - European Journal of Cancer Care December 2004 SlideThirteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued) Screening (1) Breast • A 30% reduction in mortality from breast cancer in the last 10 years in the United Kingdom • The figures are similar in the USA but have remained static in Europe (Rosin, Cancer Services Collaborative 2001) • By the end of 2004 all women in the United Kingdom will be offered routine breast screening
    14. 14. FACET - European Journal of Cancer Care December 2004 SlideFourteen *Click on “View”; “Notes Page” for explanatory notes Screening (2) Cervical • Screening is estimated to save around 1,300 lives per year • Primarily aimed at people under 65 years • Need for older women to be included in routine screening Prostate • The evidence for prostate screening is less clear than for other cancers • PSA testing fails to differentiate between slow and fast growing prostate cancers slides available at: www.blackwellpublishing.com/journals/ecc Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    15. 15. FACET - European Journal of Cancer Care December 2004 SlideFifteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Screening (3) Bowel • The incidence increases with age and is mainly a disease that affects older people • In 2000 the National Cancer Plan announced that it would implement a pilot study to look at the population most likely to benefit from bowel cancer screening Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    16. 16. FACET - European Journal of Cancer Care December 2004 SlideSixteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Comprehensive assessment • Needs to include: • Biographical data • Physical assessment • Psycho/social assessment • Cultural preferences • Multidisciplinary input • Patient and carer involvement Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    17. 17. FACET - European Journal of Cancer Care December 2004 SlideSeventeen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Single assessment • Should facilitate better communication within and between teams, and other service providers with whom the older person has contact • Reduces the need for the older person to repeat the same assessment information to a variety of service providers at a time when they are feeling vulnerable Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    18. 18. FACET - European Journal of Cancer Care December 2004 SlideEighteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Key assessment areas for older people at risk of cancer • Physical • Psychological • Social • Spiritual • Financial support Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    19. 19. FACET - European Journal of Cancer Care December 2004 SlideNineteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Key assessment areas for older people at risk of cancer • Comorbidity • Natural ageing process • Understanding of the impact of multi-pathology/chronic illness/cognitive impairment • Thorough assessment of past medical history and medication • Identifying risk factors including smoking, nutritional status Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    20. 20. FACET - European Journal of Cancer Care December 2004 SlideTwenty *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Key assessment areas for older people at risk of cancer Psychological state (1) • Impact of cancer on the older person’s sense of wellbeing • Motivation and adjustment to the situation • Quality of life Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    21. 21. FACET - European Journal of Cancer Care December 2004 SlideTwentyone *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Key assessment areas for older people at risk of cancer Psychological state (2) • Psychological support • Cognitive function • Sexuality and self image Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    22. 22. FACET - European Journal of Cancer Care December 2004 SlideTwentytwo *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Key assessment areas for older people at risk of cancer Social assessment needs to consider: • Social support networks • Carer support • Housing • Finance • The older person’s perception of health Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    23. 23. FACET - European Journal of Cancer Care December 2004 SlideTwentythree *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc Summary • Need for more research • Greater consideration of the impact of ‘normal’ ageing changes • Rights of older people to being told their diagnosis and the options available to them Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    24. 24. FACET - European Journal of Cancer Care December 2004 SlideTwentyfour *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc References and further reading • Bouchardy C., Rapiti E., Fioretta G., Laissue P., Neyroud-Caspar I., Schäfer P., Kurtz J., Sapprino A. & Vlastos G. (2003) Undertreatment strongly decreases prognosis of breast cancer in elderly women. Journal of Clinical Oncology. 21 (19): 3580-3587. • Cooley C. & Coventry G. (2003) Cancer and Older People. Nursing Older People. 15(2): 22-26. • Cunningham S. (1996) The biological basis of cancer. British Journal of Nursing. 5:14 869-874. • Department of Health (2000) NHS Cancer Plan for England. Department of Health. London. www.doh.gov.uk/cancer/cancerplan.htm • Department of Health (2001) National Service Framework for Older People. Department of Health. London • Ebersole P. & Hess P. (1998) Towards Healthy Ageing, 5th edition, Mosby. Missouri. • Eliopoulos C. (1997) Gerontological Nursing. 4th edition ch.4:p44-52; ch.7:p74-94. Lippincott. Philadelphia. Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    25. 25. FACET - European Journal of Cancer Care December 2004 SlideTwentyfive *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc References (continued) • Fee L., Cronin A., Simmons R. & Choudry S. (1999) Assessing older people’s health and social needs. Health Education Authority. London. • Gearing B. & Coleman P. (1996) Biographical Assessment in Community Care, in Birren J.; Kenyon G.; Ruth J.; Schroots J. & Svenson T. (1996) Ageing & Biography: Explanations in Adult Development. Springer. New York. Chapter 15:265-282. • Girotto J., Schreiber J. & Nahabedian M. (2003) Breast Reconstruction in Older Women: Preserving Excellent Quality of Life. Annals of Plastic Surgery. 50(6): 572-578. • Heflin MT, Cohen HJ. (2001) Cancer screening in the elderly. Hospital Practice. 36(3): 61-9. • Lewis J., Kilgore M., Goldman D., Trimble E., Kaplan R., Montello M., Houseman M. & Escarce J. (2003) Participation of Patients 65 Years of Age or Older in Cancer Clinical Trials. Journal of Clinical Oncology. 21:1383-1389. Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    26. 26. FACET - European Journal of Cancer Care December 2004 SlideTwentysix *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc References (continued) • Lichtman S. & Zaheer W. (1996) Breast cancer screening is underused, although clearly beneficial, in elderly women. Primary Cancer Care. 16(5): 5-6. • Matsushita I., Hanai H., Kajimura M., Tamakoshi K., Nakajima T & Matsubayashi Y. (2002) Should Gastric cancer Patients More Than 80 Years of Age Undergo Surgery? Journal of Clinical Gastroenterology. 35(1): 29- 34. • Nolan M. & Caldock K. (1996) Assessment: identifying the barriers to good practice. Health & Social Care in the Community. 4(2): 77-85. • Patel S. & Zenilman M. (2001) Outcomes in Older People Undergoing Operative Interventions for Colorectal Cancer: Surgery for Colorectal Cancer in Older Patients: A Systematic Review. Journal of the American Geriatrics Society. 49(11): 1561-1564. • Posner R. (1995) Ageing and Old Age. The University of Chicago Press, Chicago. Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    27. 27. FACET - European Journal of Cancer Care December 2004 SlideTwentyseven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc References (continued) • Reinbart Ayres M. (2004) Cancer and the Older Population: Considerations for Healthcare Professionals. Topics in Geriatric Rehabilitation. 20(2): 75- 80. • Repetto L. & Balducci L. (2002) A case for geriatric oncology. The Lancet Oncology. 3(5): 289-297. • Robinson J. & Turnock T. (1998) Investing in Rehabilitation. Review Findings. Kings Fund. London. • Rosin D. (2001) Breast Cancer – Cancer Services Collaborative http://www.nelh.nhs.uk/nsf/cancer/breast_sig/summary/summa • Schmitt C. (2004) Treatment Strategies for Colorectal Cancer in Older People. Journal of Clinical Gastroenterology. 38(5): 387-389. • Thomé B., Dykes A., Gunnars B. & Hallberg I. (2003) The Experience of Older People Living With Cancer, Cancer Nursing, 26(2): 85-96. Older People and Cancer: Considerations for Healthcare Practitioners (continued)
    28. 28. FACET - European Journal of Cancer Care December 2004 SlideTwentyeight *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc References (continued) • Turner N., Haward R., Mulley G. & Selby P. (1999) Cancer in old age – is it adequately investigated and treated? British Medical Journal. 319: 309-312. • Vardaxis N. (1995) Pathology for the Health Sciences. Churchill Livingstone. Edinburgh. • Westin E. & Longo D. (2004) Lymphoma and myeloma in older patients. Seminars in Oncology. 31(2): 198-205. • Wyld L., Garg D., Kumar I., Brown H. & Reed M. (2004) Stage and treatment variations with age in postmenopausal women with breast cancer: compliance with guideline. British Journal of Cancer. 90(8): 1486-91. • Yancik R., Wesley M., Reis L., Havlik R., Edwards B. & Yates J. (2001) Effects of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 285(7): 885-92. Older People and Cancer: Considerations for Healthcare Practitioners (continued)

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