Comprehensive Assessment of Senior Adult Cancer Patients

J. Piccirillo, M.D.

Project Overview:
Over the past twenty-five years, the number of cancer survivors in the United States has increased from four million in 1975 to 12 million in 2005 and is expected to reach nearly 15 million by 2010.  Of all cancer survivors, 60% are 65 years of age or older.  The current population of adults 65 and older is expected to double by 2030. In order to reduce the impact of this chronic disease on patients, their families, caregivers, and the health care system, improvements in the care of adult oncology patients is critical.  Strategies for maintaining independence of senior adult cancer survivors and their participation in community activities, improving the quality of day-to-day living, and preventing or reducing further health and functional decline that can lead to institutionalization is essential.

Cancer survivorship research focuses on the health and quality of life of a person with a history of cancer beyond the acute diagnosis and treatment phase.  Survivorship research encompasses the physical, psychosocial, and economic sequalae of cancer and its treatment and seeks to prevent and control treatment-related outcomes such as cognitive dysfunction or ‘chemo-brain’, other late effects of treatment, second cancers, and poor quality of life in order to optimize survivors’ health after cancer treatment.  Relatively little research has been performed to assess the health status of cancer survivors and even less has been performed to measure interventions, as the cancer survivor’s experience has received little clinical, research, or health policy attention; the National Cancer Institute’s Office of Cancer Survivorship is barely a decade old, as it was only established in 1996. 

Through interviews and self-reports, some researchers identified gross changes in health status and development of impairments among cancer survivors.1-3  Changes in cognition have been identified, ranging from subtle decrements in information processing to sever acute delirium.  Some of the more subtle changes might not have been characterized as a real decline by formal testing but, nevertheless, caused difficulty with day-to-day functioning for the cancer survivor.  Beyond description, survivorship research needs to include efforts to develop and test interventions to prevent or ameliorate the adverse effects.

For senior adults, unfortunately, many age-related physiological changes, comorbidities, cognitive and functional impairments may exist at the time of cancer diagnosis.  This heterogeneity in the health status of senior adult cancer patients impedes our ability to predict who is at risk for the development of complications or serious side effects of cancer therapy, decline in functional status, or ability to maintain independence, productivity, and desirable quality of life after surviving cancer therapy.

It is the Long-Term Goal of this research to improve the care of senior adult cancer patients and to help them to remain independent and active in their communities, while at the same time, helping to reduce the impact of cancer as a chronic disease on our society.  The Specific Aims of this research are to:

  • Administer a comprehensive assessment to describe the prevalence and severity of health status impairments and comorbidities present at the time of diagnoses in senior adult oncology patients and compare these findings with age-matched controls from an existing database.
  • Administer a comprehensive assessment after completion of treatment to identify health status and changes from baseline that may be a result of treatment.
  • Assess the ability of baseline health status measures to predict decline in health status and performance of daily living after treatment.

This will be an observational longitudinal pilot study of 60 senior adult oncology patients aged 70 years of age or older with a new diagnosis of cancer.

The proposed pilot project application is unique in its multi-disciplinary collaborative approach to comprehensive assessment of senior adult cancer patients, which includes novel and innovative performance-based assessments.  The proposed research aims to expand the description of the senior adult patient to a more complete level and explore interventions that improve treatment outcomes so that productive aging continues in cancer survivorship The results of this pilot study will form the preliminary data for R21 and R01 applications to the National Cancer Institute and National Institutes of Aging.

Final Report Abstract:
Over the past twenty-five years, the number of cancer survivors in the United States has continued to increase. As at 2007, there were over 11 million cancer survivors in the United States and this number is projected to reach 15 million by the end of 2010. An estimated 65% of all cancers occur in individuals 65 years of age and older so that the older adult population makes up a large percentage of cancer survivors in the United States. With the aging population of cancer survivors, strategies for maintaining the independence of senior adult cancer survivors, for improving the quality of day-to-day living, and for reducing further health and functional declines that can lead to institutionalization have become essential. Read the full Final Report.