ASCO: Knowledge Part II, Managing OC in Older Women

This early Sunday morning education session presented information on how to manage ovarian cancer in the older women. Many women including myself do get diagnosed at an early age but the median age for diagnosis of ovarian cancer in women is 63 years of age.

Ovarian Cancer Surgery in the Older Woman : Keep It Short and Sweet

Dr Linda Duska

Chronologic age is not the same as physiologic age and age does not define the ability of a woman to undergo surgery or medical treatment. Retrospective studies have showed that women with ovarian cancer who have no gross residual disease after surgery have better outcomes. Older women overall have a worse prognosis stage for stage than younger women. The GOG182 study found that there was a lower chemo completion rate among older women and that toxicity was higher. It has also been found that for women of age 65 and older surgery complications increase and there is higher mortality. It was recommended that an assessment tool like ones for frailty be used before considering surgery in women over 65. It was found that frail women were more likely to be obese and to have post-op complications.

Ovarian Cancer in the Older Women : Less is More

Dr Kathleen Moore

Studies that focus on the older woman are limited. SEER Medicare data shows that the use of chemotherapy in women decreases as age increases. Women > age 70 have higher hematologic toxicity and stop treatment early. A study done in France showed that while in pre-treatment and during treatment the geriatric assessment showed that depression was a poor prognostic factor. A US study, GOG 273 (women age 70 +)  showed that dose modifications , timing changes and variations on chemo schedule may help the older woman complete chemotherapy.

The EWOC ( Elderly Women with OC) studies showed that chemo toxicity could be predicted by 3 factors – depression, dependence and performance status.  The MITO-5 and MITO -6 studies found that weekly carbo taxol was associated with lower toxicity and higher quality-of-life scores.

Clinical Trials in the Older Patient: Who,When and Why?

Dr William Tew

There are not many clinical trials for older patients.

Dr Tew stated that it is important to define who your patient is and what they want. He also recommended assessing functional age not chronologic age. The Cancer and Aging Research Group has developed and assessment tool that can be used before starting chemotherapy. The assessment tool looks at factors that can predict grade 3-5 toxicities in older patients. Some of the tool variables are age, impaired hearing, inability to walk a block, decreased social activity etc.

From this session I learned that:

• better outcomes occur when older women finish chemotherapy- even if that means the dosage/timing needs to  need modified.
• Depression and poor functional ability can impact treatment success
• Age itself does not predict whether or not a woman can undergo surgery or treatment .
• Assessment tools ( fraility / performance status) should be used before surgery

Tomorrow’s post will be on Value Concepts in the Management of Ovarian Cancer

Dee

Every Day is a Blessing!

Sessions Older Cancer Survivors and Caregivers – Cancer Survivorship Research Conference Part 2

There were a number of concurrent sessions taking place at the Cancer Survivorship Research Conference so it was difficult for me to decide which ones to attend in person. I will share with you information from the Improving Health and Health care  of Older Americans and Caring for the Caregivers which I found most interesting. .

Improving Health and Healthcare of Older Americans

In this session I learned from Heidi Klein, MD that older Americans ( >65 years of age) was the largest group ( 53%) of cancer survivors. But they are also the group to which we know very little about.  Why? Older adults are underrepresented in clinical trials because many times the age group is ineligible due to the way many trial protocols are written. Currently,  researchers are unsure if the standard of care will apply for those >65 years of age. There is a relatively young specialty called Geriatric Oncology and a group specifically doing research in this area called the Cancer and Aging Research Group.

Dr Supriya Mohile spoke about using the Geriatric Assessment to aid in cancer treatment decision making and to predict which patients will experience acute toxicity of chemotherapy . The geriatric assessment includes functionality, physical performance, cognition, nutrition, social support , etc.  Dr Mohile stated that patients with cancer have had a higher prevalence of geriatric issues. There has been very little research on survivorship issues with the older adult. They do know that with chemotherapy older adults have more neuropathy which leads to more falls.

Dr. Ed McAuley spoke about physical activity interventions and that the median age of those diagnosed with cancer is 65 years. He also stated that only 10% of those 65 years of age and over are meeting physical activity guidelines. Many believe walking is enough but strength training is important too.  Physical activity also has an impact on cardiovascular function. In a study of breast cancer patients, researchers found that the more physical activity patients undertook the less fatigue the patients experienced and indirectly the less depression the patients felt.

Albert Sui , MD explained that longevity is increasing due to better public health, less smoking and cleaner water. With the longevity though come and increase in chronic conditions which cancer patients have to deal with. It was stated repeatedly that doctors need to consider comorbitity issues when treating older cancer patients. 

Caring for the Caregiver

This session began with a presentation by Sharon Manne, PhD discussing Coupled Focused Psychological Interventions for Cancer Patients. Cancer is a family and couple stressor. Her work compared support group interventions for couples( breast cancer dx)  versus an enhanced couple focus intervention. In this study, there was less work absenteeism (one outcome of the study) by the partner in the enhanced couple focused group. They also found the higher the stage at diagnosis the higher the spouse/ partner stress. In a study of prostate cancer patient/ couples, researchers found that the more the patient held back from discussing issues with their partner the lower levels of well-being the partner felt.  

Allison Applebaum, PhD from the Center for the Study of Cancer Caregivers at Memorial Sloan Kettering explained that cancer caregivers are also cancer survivors (NCI definition). Caregivers are at agreater risk for distress and have anxiety regarding recurrences even up to 5 years later so it is important that caregivers learn to manage their stress.

Patricia Griffiths, PhD a gerontologist  spoke about Caregiving Dyads. There is currently a dementia home tele-health model program used by the VA. Programs like this can be modified to reflect survivorship concerns and expanded to Google chats ( which I learned are HIPAA compliant).

Next up post - Survivorship Guidelines.

Dee Every Day is a Blessing!