Tue, Mar 24, 2009 - Page 16 News List

The neglected front in the war against cancer

Although about 60 percent of newly diagnosed cancers occur in people over the age of 65, there is little research concerning treatment for the many forms of cancer that afflict the elderly

By Jane E. Brody  /  NY TIMES NEWS SERVICE , NEW YORK

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Elliot was 83 when a routine checkup that included a digital rectal exam suggested prostate cancer. A biopsy then revealed that he had an aggressive form of the disease. His doctor recommended treatment despite Elliot’s age and several existing problems, including mild cases of high blood pressure, Type 2 diabetes, depression and angina, all of which were being treated with medication.

Elliot also has leg pain that limits his walking. But none of his health problems interferes with his weekly bridge game or nights out for the theater, concerts and dining. When cancer popped into the equation, Elliot, a man with a self-deprecating sense of humor always at the ready, said he was just not inclined to let it end his life.

So when the doctor suggested hormone and radiation therapy, five days a week for nine weeks, Elliot did not hesitate. Except for some radiation-induced fatigue that he noticed only after therapy was over, he sailed through the treatment. Three months after finishing his therapy, his PSA, a blood test for possible cancer, registered zero, suggesting that the malignancy was destroyed.

The outcome for Elliot is a direct assault on the oft-given advice that most cancers affecting people his age be left to take their course. The theory is that either the treatment will kill them or destroy their quality of life, or some other health problem will kill them before the cancer does.

But there is a great paucity of factual information to support either a wait-and-watch approach or an aggressive approach to treating cancer in the elderly.

Although about 60 percent of newly diagnosed cancers occur in people 65 and older, there is little research to help doctors and patients decide how, when and even whether to treat the many forms of cancer that afflict older people, especially those with other ailments that can complicate therapy.

LIMITED RESEARCH

For a variety of reasons, older cancer patients are rarely included in clinical trials that test new therapies, so relatively little is known about potential responses to treatment under various circumstances.

Research protocols commonly eliminate people with chronic health problems, in case the therapy makes those problems worse or the medications patients are taking interact poorly with the treatment being studied. Another deterrent is limited longevity in the elderly, making it difficult to determine the long-term effectiveness of a treatment.

Patients themselves can be a problem, if they fear “being experimented upon,” if they are not physically able to get to treatment facilities or if the research protocols are too difficult for them to understand and follow.

Despite the limited research, one fact is clear: There is no “one size fits all” treatment for cancer in the elderly. Whether the patient is 60, 80 or 100, a host of factors — medical, practical and emotional — must be taken into account when devising a therapeutic plan. To the distress of some families, decisions are too often based more on a patient’s chronological than physiological age.

“The doctor may be dealing with two 65-year-old patients with the same disease,” Jerome W. Yates, national vice president for research at the American Cancer Society, said in an interview. “Yet one is like a 55-year-old, healthy, strong and resilient, and the other is more like an 85-year-old, frail and chronically ill. Each should be treated differently.”

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