Cancer care for older adults may not be based on strong evidence, according to a 2013 report from the National Academy of Medicine report that found there are simply too few clinical trials on how adults, especially over the age of 75, respond to or tolerate new cancer therapies. Most studies look at younger cancer patients with fewer additional illnesses complicating their treatment. As a first step in addressing this challenge in the field of geriatric oncology, Ginah Nightingale, PharmD, Associate Professor in the Jefferson College of Pharmacy (Philadelphia University + Thomas Jefferson University), and researcher at the Sidney Kimmel Cancer Center – Jefferson Health, scoured the literature to compile a review that includes guidance on many drugs, including immunotherapies, with an eye for functional age. The article was published in the Journal of Geriatric Oncology.
Here are a few takeaways from that article:
1. Watch out for polypharmacy – One of the biggest concerns for oncologists treating older cancer patients is the risks that the cancer treatment will interact negatively with any of the many other medications older people take. Older adults are prescribed as many as 5-10 medications at once, and certain combinations can interact in unexpected ways with cancer therapies. For example, drugs for reflux (proton pump inhibitors) that are commonly prescribed in older populations can alter how cancer therapies are absorbed, potentially changing the dose that would be effective. To avoid complications, write or type up a card with a complete up-to-date list of medications, and include any natural or alternative medicines, including extracts or teas, some of which can also interact negatively with cancer drugs.
2. Scan the drug insert – How our bodies digest, absorb, and filter out medicine changes as we age. Older liver and kidneys tend to process and filter drugs less efficiently than younger bodies, which means that treatment regimens designed for younger patients might stay in the body longer in older adults whose drug filtration is slower. Check the package insert of the drug you’ve been prescribed for special instructions on how to adjust based on organ function. You can also ask the doctor if the medicines might act differently in older adults with problematic function.
3. Follow directions on diet especially with newer cancer drugs – Targeted therapies such as kinase inhibitors, monoclonal antibodies, and immunotherapies can be particularly risky in part because they are newer and there is fewer data collected on how well older adults tolerate these therapies. Even oral drugs have dietary considerations. It’s important to take diet seriously, and talk to your pharmacist or registered dietician about the food types and volume that will give the best outcomes.
4. Help manage symptoms for best treatment outcomes – Successful cancer treatment depends on keeping medicines at the right dose – enough to kill the cancer, but not so much that the side effects become unbearable. But getting to and from appointments, staying on top of complicated oral cancer regimens (such as, take twice daily with food for 14 days out of 21 days), and making appointments for follow up and/or laboratory tests can be challenging. Whether an individual has access to regular and reliable caregiver support may affect how well that patient can adhere to the treatment plan, and therefore how well the treatment works. Develop a network of support of neighbors, friends, and family who can help ensure you, or the cancer patient in your life, attain your treatment goals.
5. Find ways to help reduce the social and economic impact of cancer care – research shows that social isolation can increase chemotherapy toxicity. In addition, financial toxicity is a serious concern for older adults on fixed incomes, in terms of affording standard treatment as well as newer immunotherapies, which can be much more expensive. If you or your loved one is struggling to manage or afford care during cancer treatment, ask to speak with a social worker who specializes in oncology. That person is usually well versed in local organizations that can provide support.
Article reference: Ginah Nightingale, Rowena Schwartz, Ekaterina Kachur, Brianne N. Dixon, Christine Cote, Ashley Barlow, Brooke Barlow, Patrick Medina, “Clinical Pharmacology of Oncology Agents in Older Adults: A Comprehensive Review of How Chronologic and Functional Age Can Influence Treatment-Related Effects,” J Geriatr Oncol, DOI: 10.1016/j.jgo.2018.06.008, 2018.