Caring for the Older Patient with Cancer in the Primary Care Setting. Janine Overcash, PhD, GNP-BC. University of South Florida

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1 Caring for the Older Patient with Cancer in the Primary Care Setting Janine Overcash, PhD, GNP-BC University of South Florida (813) cell phone Objectives At the end of the presentation the learner will be able to: identify three (3) treatment modalities for solid tumors (breast, colon, lung, prostate cancers) in older adults; identify three (3) adverse symptoms associated with cancer treatment in older cancer patients; identify three (3) comorbid conditions and the relation to cancer; identify three (3) common psychosocial concerns associated with the care of the older cancer patient; identify two (2) online resources which are appropriate for references concerning the treatment regimes of the older cancer patient.

2 Outline Demographics of Aging and Cancer in the US Cancer is a disease of the aged Heart-related diagnoses account for most comorbid conditions Definition of Cancer Cancer is a term used for diseases in which abnormal cells divide without control and invade other tissues and organs (NCI, 2009). Classifications of Cancer Solid Tumors Liquid Tumors Over 100 different types of cancer Carcinoma Sarcoma Leukemia Lymphoma and Myeloma Central Nervous System Cancer Cancer treatment Considerations Specific to Older People Who is most likely to receive cancer treatment?

3 Cancer Treatment Surgical Systemic Therapy Chemotherapy Hormonal Therapy Radiation Therapy Adverse Effects Chemotherapy Radiation Therapy Hormonal Therapy Cormorbid Conditions and Relation to Cancer Diabetes Mellitis Arthritis

4 Cardiac Diagnosis Symptom Management of Cancer Treatment Effects Neutropenia/Anemia Pain Constipation Fatigue Psychosocial Concerns Social Support Networks Living Along Caregivers

5 Transportation Cancer Related Resources Aimed at Caring for the Older Person National Comprehensive Cancer Network NCCN.org American Cancer Society ACS.org Oncology Nurses Society ONS.org National Cancer Institute NCI.org

6 Table 2: Adjuvant Systemic Treatment Options for Women With Axillary Node-Negative Breast Cancer Patient group Low risk Intermediate risk High risk * Note: This treatment option is under clinical evaluation. Premenopausal, ER-positive or PRpositive None or tamoxifen Tamoxifen plus chemotherapy, tamoxifen alone, ovarian ablation, GnRH analog* Chemotherapy plus tamoxifen, chemotherapy plus ablation or GnRH analog*, chemotherapy plus tamoxifen plus ovarian ablation or GnRH*, or ovarian ablation alone or with tamoxifen or GnRH alone or with tamoxifen Premenopausal, ER-negative or PRnegative Chemotherapy Postmenopausal, ER-positive or PRpositive None or tamoxifen Tamoxifen plus chemotherapy, tamoxifen alone Tamoxifen plus chemotherapy, tamoxifen alone Postmenopausal, ER-negative or PRnegative Chemotherapy Older than 70 yearsnone or tamoxifen Tamoxifen alone, tamoxifen plus chemotherapy Tamoxifen; consider chemotherapy if ER-negative or PR-negative

7 References Barford, K. L., & D'Olimpio, J. T. (2008). Symptom management in geriatric oncology: practical treatment considerations and current challenges. Curr Treat Options Oncol, 9(2-3), Bokemeyer, C., Honecker, F., Wedding, U., Spath-Schwalbe, E., Lipp, H. P., & Kolb, G. (2002). Use of hematopoietic growth factors in elderly patients receiving cytotoxic chemotherapy. Onkologie, 25(1), Clark, P. (2001). Chemotherapy in oesophageal cancer. Clin Oncol (R Coll Radiol), 13(3), Coughlin, S. S., Calle, E. E., Teras, L. R., Petrelli, J., & Thun, M. J. (2004). Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. Am J Epidemiol, 159(12), Droz, J. P., Aapro, M., & Balducci, L. (2008). Overcoming challenges associated with chemotherapy treatment in the senior adult population. Crit Rev Oncol Hematol, 68 Suppl 1, S1-8. Du, X. L., Xia, R., Liu, C. C., Cormier, J. N., Xing, Y., Hardy, D., et al. (2009). Cardiac toxicity associated with anthracycline-containing chemotherapy in older women with breast cancer. Cancer. Elwing, J. E., Gao, F., Davidson, N. O., & Early, D. S. (2006). Type 2 diabetes mellitus: the impact on colorectal adenoma risk in women. Am J Gastroenterol, 101(8), Fisher, B., Jeong, J. H., Bryant, J., Anderson, S., Dignam, J., Fisher, E. R., et al. (2004). Treatment of lymph-nodenegative, oestrogen-receptor-positive breast cancer: long-term findings from National Surgical Adjuvant Breast and Bowel Project randomised clinical trials. Lancet, 364(9437), Gomez-Millan, J. (2009). Radiation therapy in the elderly: more side effects and complications? Crit Rev Oncol Hematol, 71(1), Goodwin, J. S., Hunt, W. C., & Samet, J. M. (1991). A population-based study of functional status and social support networks of elderly patients newly diagnosed with cancer. Arch Intern Med, 151(2), Lange, P. H., Lightner, D. J., Medini, E., Reddy, P. K., & Vessella, R. L. (1990). The effect of radiation therapy after radical prostatectomy in patients with elevated prostate specific antigen levels. J Urol, 144(4), ; discussion Mantz, C. A., Dosoretz, D. E., Rubenstein, J. H., Blitzer, P. H., Katin, M. J., Garton, G. R., et al. (2004). Endobronchial brachytherapy and optimization of local disease control in medically inoperable non-small cell lung carcinoma: a matched-pair analysis. Brachytherapy, 3(4), Meacham, L. R., Sklar, C. A., Li, S., Liu, Q., Gimpel, N., Yasui, Y., et al. (2009). Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with radiation therapy: a report for the childhood cancer survivor study. Arch Intern Med, 169(15),

8 Milecki, P., Kwias, Z., & Martenka, D. J. (2007). Radiotherapy combined with hormonal therapy (RT-HT) in prostate cancer patients with low, intermediate, and high risk of biochemical recurrence: perspective and therapeutic gain analysis. Neoplasma, 54(1), National Cancer Institute (2005). SEER Cancer Statistics Review, Table I-21, US Prevalence Counts, Invasive Cancers Only. Paulson, D. F., Moul, J. W., Robertson, J. E., & Walther, P. J. (1990). Postoperative radiotherapy of the prostate for patients undergoing radical prostatectomy with positive margins, seminal vesicle involvement and/or penetration through the capsule. J Urol, 143(6), Reed, M. W., Audisio, R. A., & Wyld, L. (2009). The role of surgery in the treatment of older women with breast cancer. Clin Oncol (R Coll Radiol), 21(2), Roy, L. D., Pathangey, L. B., Tinder, T. L., Schettini, J. L., Gruber, H. E., & Mukherjee, P. (2009). Breast cancerassociated metastasis is significantly increased in a model of autoimmune arthritis. Breast Cancer Res, 11(4), R56. Wildiers, H., Kunkler, I., Biganzoli, L., Fracheboud, J., Vlastos, G., Bernard-Marty, C., et al. (2007). Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol, 8(12),

Cancer Endorsement Maintenance 2011-Maintenance Measures

Cancer Endorsement Maintenance 2011-Maintenance Measures Measure Number Title Description Measure Steward 0210 Proportion receiving chemotherapy in the last 14 days of life 0211 Proportion with more than one emergency room visit in the last days of life 0212