Two New Guides Released to Help Older Patients with Cancer

While cancer diagnoses have been increasing among younger adults, cancer is still more common in older adults, particularly those 60 years and older. As the population ages, the number of cancer cases is expected to rise, underscoring the need to tailor treatment strategies for older adults.

Today, the National Comprehensive Cancer Network® (NCCN) — an alliance of leading cancer centers — published the NCCN Guidelines for Patients®, Older Adults with Cancer, a new resource to help patients and caregivers understand the importance of assessments in cancer care and develop a treatment plan that best fits their needs.

The new guidelines for older patients were developed from the NCCN Clinical Practice Guidelines in Oncology, Older Adult Oncology, which were released Sept. 4. Both the clinical and patient versions of the guidelines include information about which assessment tools are available and how they should be used to help make decisions.

Louise C. Walter, MD, UCSF chief of Geriatrics, member of the UCSF Helen Diller Family Comprehensive Cancer Center, and vice-chair of the NCCN Guidelines Panel for Older Adult Oncology, helped to guide a diverse complement of stakeholders in developing these new guidelines.

“These patient guidelines help explain how to determine the right treatment for the right person based on their unique situation and preferences,” said Walter. “We all age differently. People should really be talking with their doctor about what makes sense for them as an individual, with their specific health situations, and come up with the best plan that's not based on chronologic age, but on what’s most important to them. The more informed a person can be, the better care they’re going receive, because they’re going to ask better questions.”

Some need more support than others

The guidelines flag ways to support people with cognition issues, or at higher risk for falls. They are geared toward anyone diagnosed with cancer over the age of 65 but could be relevant for younger patients with additional medical concerns. While the likelihood of side effects and comorbidities increase with age, the guidelines stress there is a wide range of mental and physical fitness that people can experience well into their 80s, 90s, and beyond.

“We are seeing more and more people being treated for cancer at an advanced age,” explained Efrat Dotan, MD, Abramson Cancer Center at the University of Pennsylvania, chair of the NCCN Guidelines Panel for Older Adult Oncology. “We need to carefully assess any patient over 65, because there can be a huge range in areas such as memory function, physical ability, or treatment interactions with other medications and conditions. This resource explains what support is needed and suggests how to talk to your doctor about it.”

The guidelines for older adults cover nearly every type of cancer, plus prevention, screening, and supportive care topics like survivorship, fatigue, and distress management.

Clinical leadership in cancer and geriatrics

In addition to her involvement with the NCCN Guidelines for Patients panel, Walter was also very involved in co-leading the practice guidelines for clinicians. Those guidelines are designed for practicing clinicians who provide medical care for older adults with cancer. The NCCN older adult oncology guidelines group included members from each of the Comprehensive Cancer Centers across the U.S. and a mix of oncology specialties and geriatricians.

Walter has also transformed the approach to cancer screening in older adults. She has developed novel methodology demonstrating the fundamental importance of life expectancy rather than age in determining benefits and risks of screening. In 2014, Walter’s JAMA article, “Cancer Screening in Elderly Patients: A Framework for Individualized Decision Making,” was selected in a national survey of geriatricians as one of the 27 landmark articles that have advanced the field of Geriatrics.

Walter also led a series of seminal studies demonstrating decisions to screen older adults for cancer are often dictated more by age than health such that many patients in poor health continue to undergo screening while many healthy older patients fail to get screened. Also, she discovered that cancer screening frequently leads to significant harms without benefit in patients in poor health and developed a classification and quantification of screening harms. This quantification of negative health impacts has also been applied to study outcomes of other procedures performed in frail older adults in poor health, such as tight glycemic control, chemotherapy, and surgery.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to defining and advancing quality, effective, equitable, and accessible cancer care and prevention so all people can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus-driven recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the National Comprehensive Cancer Network Foundation (NCCNF). NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.

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