Study Calls for “Staging the Aging” When Cancer Strikes

Jul. 29, 2009

 Just as it is important to know the stage of cancer at diagnosis, a new study proposes that older people with cancer should be further classified or “staged” into subgroups based on other health issues they face.

The University of Rochester Medical Center study, published in this week’s Journal of the National Cancer Institute, is the first step toward “staging the aging” when it comes to geriatric cancer patients, said lead author Supriya Mohile, M.D., a geriatric oncologist and assistant professor at the James P. Wilmot Cancer Center at URMC.

Cancer is primarily a disease of the aging, and older people with cancer are more likely to be frail and vulnerable compared to older people without cancer, Mohile’s study showed. This will pose a challenge for oncologists as the population ages.

Supriya Mohile, M.D.

“In our analysis, relative risk estimates show that a cancer diagnosis increases the probability of being more vulnerable or frail by 9 to 33 percent, compared to those without cancer,” Mohile said.

Estimates are that 50 percent of all malignancies in the United States occur in people who are at least 65 years old, with projections that by 2030 about 70 percent of cancer patients will be older.

Yet many older people do quite well after cancer treatment, especially those who are fit and independent. Mohile sees patients who are up to 100 years old and live well.

One such patient, 92-year-old Louis Falzer, of Rochester, survived prostate cancer and is enjoying his longevity. His secret, he said, “is not crawling into a corner,” and instead focusing on eating right, staying active – he was a runner into his early 80s -- and keeping a sharp mind with the help of part-time work, puzzles and books, and a close circle of friends.

At present, however, no evidence-based tools exist to accurately predict who will fall into this category.  

 “In the future, we plan to develop and validate tools that assess underlying vulnerabilities, and design clinical trials that not only improve survival, but allow older adults to restore or improve their quality of life,” Mohile said.

To better understand the effect of a cancer diagnosis on vulnerability and frailty, researchers analyzed the 2003 health records of 12,480 Medicare beneficiaries (age 65 or older), a nationally representative sample of the elderly population. About 19 percent reported a non-skin cancer diagnosis, most often colon, breast or prostate cancer, ranging from recent metastatic disease to having been a long-term survivor.

Researchers then used two widely accepted assessment scales to evaluate vulnerability and biologic frailty, two common conditions that impair the lives of older people.  

Compared to the people who had never had cancer, the cancer group reported significantly higher rates of an inability to care for oneself (bathing, cooking, light housework), higher rates of unrelated illnesses, and classic geriatric syndromes such as dementia, depression, incontinence and falls.

“It’s important to realize that older patients are a very heterogeneous group,” Mohile said. “Future research should focus on identifying which cancer patients are at the highest risk for developing life-threatening impairments as they face cancer treatment.”

Mohile’s study was funded by the Hartford Health Outcomes Research Scholars Award. Co-authors from the University of Rochester Medical Center include: Ying Xian, M.D., Susan G. Fisher, Ph.D., Gary R. Morrow, Ph.D., and William Hall, M.D.