Sun, Dec 19, 1999 page2

• Elderly not always given the best cancer treatment

  HEALTH CARE Elderly victims of cancer tend to receive less aggressive treatments for the disease. This is partly due to a tendency by doctors to relate a patient's age to the state of his health

  • By Erin Prelypchan / STAFF REPORTER
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  Although older people are more likely to get cancer, they are less likely to get aggressive treatment from their doctors, oncologists said yesterday.

  Older people "do not get sent to cancer centers, they don't get the right advice from experts or specialists and they aren't [properly] treated," said Dr Paul Carbone, an oncologist at the University of Wisconsin Medical School's Comprehensive Cancer Center.

  Citing the results of a series of studies conducted through the Eastern Cooperative Oncology Group in the US, patients over 65 were more likely to be treated in small, unspecialized facilities and treated surgically as opposed to being given a variety of other techniques.

  For solid mass cancers, older patients are given radiation and chemotherapy less often, but respond successfully to aggressive treatment at comparable rates to their younger counterparts, he said.

  Carbone cited the case of a retired university professor who had hepatoma, a difficult-to-treat liver cancer. Carbone recommended two aggressive chemical therapies.

  "He bet me a nickel he would get better. I normally don't wager with my patients, but I thought this was a reasonable case," Carbone said.

  The 95-year-old patient, who was vital and insistent on thorough treatment, improved dra-matically and died eight years later of causes unrelated to the cancer.

  "Don't look at a man's age, look at his physiology," Carbone said.

  Doctors may be confusing a patient's age with the state of his or her health and assuming that he or she is too frail to undergo chemotherapy or radiation -- two forms of treatment that the elderly can respond to just as well as the young, Carbone said.

  Aging does affect three organs in particular, he said: the kidneys, heart and lungs.

  Some chemical therapies are particularly hard on these three internal organs, but the elderly can be treated with therapies suited to reduced organ function, he said.

  The fault with less specialized, less comprehensive treatment does not necessarily lie with doctors, Carbone said.

  Older cancer patients may be more reluctant to seek therapies, or may not want to relocate to specialized cancer centers because of their families or spouses.

  Here in Taiwan, where cancer is the leading cause of death, treatment for the elderly suffers in a similar way, said Taiwan's top oncologist.

  "For [older people], we always hesitate to treat them," said Dr Jacqueline Whang-Peng (彭汪1鑄d), director of cancer research at the National Health Research Institutes.

  But the reasons why older cancer patients in Taiwan are treated less aggressively are perhaps not the same as for those in the US, Whang-Peng said.

  Patients in Taiwan tend to defer to the opinion of their doctors, so if doctors don't suggest aggressive therapy, patients are unlikely to request it, she said.

  Families of older cancer patients are also unwilling to subject their loved ones to chemotherapy, believing that it will make them sick and weak.

  "We try to tell people that cancer is not an incurable disease, and that there are a lot of ways by which it can be effectively treated, and that the treatments are not deadly poisons," Whang-Peng said.

  As Taiwan's life expectancy increases and the population ages, cancer among the elderly is expected to rise dramatically, she said.

  Those over 60 accounted for nine percent of the population in 1989, and 11 percent in 1997, according to Department of Health statistics.
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