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Older Adult Cancer Survivors – Understanding the Challenges

Chances are, you know someone who has been touched by cancer in some way. But you may be surprised to learn that the majority of cancer survivors — a full 60% — are over the age of 65.

“There are 10.8 million Americans — 3.7% of the U.S. population — with a history of cancer,” explains Karen Meneses, PhD, Associate Dean for the UAB School of Nursing. “While survival rates are increasing, there are significant challenges for older adult cancer survivors in obtaining a follow-up plan of care, understanding how to care for themselves after treatment, and getting the social support they need to deal with the range of emotions that are part of being a cancer survivor.”

Dr. Meneses specializes in clinical research with breast cancer patients who have completed therapy. “Breast cancer is the most common type of cancer in women, and it is also a disease that primarily affects older women,” she explains. “The average age of diagnosis is 61, with women in the 75-79 age group having the highest incidence of the disease.”

Data show that older women have the best survival rates of breast cancer. “A survivor is anyone at the time of diagnosis and beyond,” she explains. “Survivors would include the newly diagnosed, those who have completed treatment with no evidence of disease, those who have completed treatment and have a recurrence of cancer, and those receiving palliative, or end-of-life, care.”

3 Common Challenges for Older Adult Cancer Survivors

“Several reports compiled by the National Cancer Institute (NCI) and the Institute of Medicine (IOM) give us important information about how older people survive with a history of cancer — and the challenges of being a cancer survivor,” says Dr. Meneses.

1. Lack of a Follow-Up Plan of Care.

The IOM has found that older adult cancer patients often don’t receive a consistent follow-up plan of care once treatment has ended. “Older patients tend to fall through the cracks and don’t return for follow-up appointments as they should,” explains Dr. Meneses. She stresses that the recommended schedule for follow-up care after treatment is:

  • First year after treatment — every 4 to 6 months
  • Second year after treatment — twice a year
  • Third year after treatment and beyond — yearly follow up

“All too often, these guidelines aren’t being followed by older adult survivors,” says Dr. Meneses. “Patients are often told to see several specialists, and there can be confusion about which doctor to see first. Planning visits with multiple doctors can be logistically difficult for older patients if the specialists are in different physical locations. Also, rural patients have difficulty driving long distances to doctors’ appointments.”

Dr. Meneses suggests that a family member, support person, or “patient navigator” — an individual who remains in contact with survivors on a monthly basis for the first year after treatment — could be an invaluable way to minimize confusion and help survivors stay with the follow-up guidelines.

2. Lack of Education about Self-Care.

Most cancer treatments have side effects that can range from mild to severe. Knowledge about self-care after treatment is important for cancer survivors in dealing with these side effects and preventing treatment-related health problems.

“Many older breast cancer patients aren’t informed about the side effects of treatment and how to care for themselves after treatment has ended,” Dr. Menses explains. “For example, some women don’t realize that it’s very important to wear sunscreen after radiation treatment. Also, because common treatments can cause calcium and bone loss, it’s important to get enough calcium and vitamin D through diet and supplements. DEXA scans are also recommended yearly to every 18 months once breast cancer treatment has ended. We must focus on better ways of providing patients with important self-care information such as this.”

3. Lack of Social Support.

Receiving support from others is important for older cancer survivors, who often deal with feelings of isolation and fear that their disease will return. Yet, older adult survivors are often lacking this critical form of support.

“There may be no one to talk to about what is normal,” says Dr. Meneses. “Older adults typically don’t use the Internet to get information or connect with others. Also, there are few support services for older survivors living in rural areas of the country.”

She points out that many older breast cancer survivors may also be caring for other family members, including grandchildren. “When breast cancer runs in the family, older women tend to be the major support for younger women.”

Dr. Meneses concludes that more consistent forms of education, information, and follow-up care are needed to ensure that older cancer survivors can lead lives that are as full and healthy as possible. “We want to focus on improving quality of life for older adult cancer survivors, who have shown such resilience and strength in fighting their disease.”

Article last updated: July 7, 2009 11:14 AM