Saturday, May 28, 2005

Cancer rate is expected to surge

By Donna Wright
Source: Contra Costa Times


Cancer and aging experts warn that the aging of the baby boom population will create a cancer epidemic. For evidence they point to the numbers.

Half of all cancers now occur in people age 65 and older.

The first wave of boomers -- those born between 1946 and 1964 -- will be retiring within the coming decade.

The convergence of those two trends 20 years from now will result in 70 percent of all cancers occurring in the 65-and-older population, said Dr. Lodovico Balducci, program leader of the Senior Adult Oncology Program at H. Lee Moffitt Cancer and Research Center in Tampa, Fla.

Balducci warns that the coming epidemic will tax current medical resources to deal with the increase in cancer cases.

The treatment of cancer, Balducci said, is more complex for the elderly because of the aging process and the fact that most seniors have other complex medical problems that must be factored into their care.

Too few doctors are ready or able to provide that expertise, Balducci said.

Moreover, most clinical trials for new cancer treatments and drugs cut off at age 60.

Very little of what is learned in those trials, Balducci said, can be applied to the challenges of treating older cancer patients -- who most typically have a cluster of chronic conditions.

Balducci sees boomers themselves as the agents of change that will force the medical community to expand treatment of cancer in the elderly.

Dr. William E. Haley, professor and director of University of South Florida's School of Aging Studies, agrees. The coming cancer epidemic will have a profound effect on every level of society, he said.

Yet boomers are prepared to be their own advocates, according to Haley.

Aging boomers won't fit the mold of their retired elders, the USF experts said. Highly educated, boomers are known for their assertiveness and their demands, backed by their sheer numbers in making society change to fit their expectations.

They are used to being in control, says Dr. Bruce Robinson, chief of geriatrics for Sarasota Memorial Hospital.

At 53, Robinson is a boomer himself, so he knows what he is talking about.

He also knows that some of his colleagues in the doctor's lounge look to a future caseload of aging boomers with trepidation, even frustration.

"Boy, I hate baby boomers," one doctor told Robinson. "They want information. They want to be involved. They want answers."

Robinson's sees boomers' demands for involvement in their care as an important advantage.

"It's a win/win opportunity," said Robinson, a nationally known geriatrician (a specialist in the care of the elderly).

Patients need to become more effective in handling their own health problems, he said.

"Most medical problems plaguing the elderly are chronic diseases that require long periods of involvement," Robinson said. "The issue is how do you best manage your life, how do you participate in best preserving your health when presented with one of these problems?"

As more is learned about how malignancies develop and more effective treatments come on line, cancer is fast becoming a managed chronic disease rather than a death sentence, Balducci said.

Most people older than 65 already have to handle two or more chronic conditions, Balducci said. Diabetes, hypertension, heart disease and respiratory conditions top the list.

Moreover, as we age our body's metabolism slows down. The physical changes of aging add challenges to prescribing effective cancer treatment for the elderly, Balducci said.

Dr. Nagi Kumar, director of Moffitt's Department of Nutrition, estimates that 60 percent of people older than 65 suffer from malnutrition. The causes, Kumar said, are numerous: the body's slowing metabolism, loss of taste sensation that begins at age 60, decreased thirst, malabsorption of nutrients in food consumed and tooth problems, including poor-fitting dentures that can make eating difficult or painful.

Moreover, most primary care physicians have neither the time during a typical office visit nor the skill to assess the complex medical challenges facing the elderly cancer patient, Robinson said.

Too often, the aging cancer patient is written off because too few health care providers understand the unique needs of the elderly or how to manage several chronic conditions at once, said Balducci.

Yet, new treatments and promising discoveries on how to control cancer by modifying genetic triggers that regulate cancer growth offer more tolerable and more effective treatments for the elderly.

"Treatment can be as effective in the elderly patient as in a younger patient," Balducci said.

But often those treatments are not offered to seniors, because socially accepted myths about aging are rampant in the medical profession, he added.

Balducci finds it frustrating that our youth-centered culture fails to understand that treatment can be as effective in an elderly patient as a younger person, if approached from the right perspective.

That perspective flows from a realization, he said, that life can be pleasurable for people in their 70s, 80s and 90s, even for those who have two or more chronic diseases.

Balducci warned that the coming cancer epidemic in the elderly will force the medical profession to change.

That change, he added, will not come from within the profession but from without -- namely the pressure baby boomers exert on the health care system to pay attention to aging issues.

The bottom line: Balducci warns that neither the medical community nor society in general can afford to ignore the coming cancer epidemic in the elderly.

"If we are to control cancer, we must control cancer in the elderly population," Balducci said.

Boomers themselves must become advocates for better care of the elderly.

Doctors, Robinson believes, must become better educators, guiding patients to accurate sources of information that will help them understand the medical conditions they must manage.

He sees the day when doctors will play the role of a medical reference librarian, with a range of sources at their fingertips to guide patients.

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Copyright ©2004 Contra Costa Times. All Rights Reserved.

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