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Detailed exams might benefit older cancer patients

By Kathleen Raven

NEW YORK (Reuters Health) - Older people with cancer who seem to be coping well with the disease might still earn poor health scores when examined by a geriatrician, according to a new analysis of past studies.

The review focused on older people with leukemia and lymphoma. The findings suggest detailed examinations of those patients provide a better, more nuanced picture of their health for oncologists making treatment decisions, researchers said.

"Most of what we know about treating cancer comes from research that was done in young, fit patients," Dr. Marije Hamaker wrote in an email to Reuters Health.

Hamaker, a geriatrician at Diakonessenhuis, a hospital in Utrecht, The Netherlands, led the new review.

"It is incorrect to assume that what is best for a younger person will also be best for someone who is older," Hamaker said.

She and her team reviewed 18 published studies that looked at geriatric assessments among people with blood and bone marrow cancers. Those patients were 73 years old, on average.

The researchers found that patients who scored well on a simple health scale tied to daily activities were actually struggling in other areas especially relevant to the elderly, like cognitive function, depression, social environment, nutrition, medication interactions and frailty.

Ten of the studies examined relationships between geriatric assessment scores and death. They showed poor physical performance measured at a clinic and worse nutrition were consistently linked to a higher chance of dying early.

In the past, an older person's mental and physical decline, as well as declining social networks, were "written off as part of the aging process," said Dr. Heidi Klepin. "And yet all of those things have a major impact on how a person handles a disease."

Klepin, who was not part of the study, is an oncologist trained in geriatric care at the Comprehensive Cancer Center at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

"We don't have a lot of knowledge on older patients because they are rarely included in clinical trials," she said. That's because those trials often leave out people who have other health complications.

But, "there's an ever-increasing number of older patients being diagnosed with cancer," she said, and older patients require more complex care than younger ones.

Nearly one third of new blood and bone marrow cancers occur in adults over age 75, the researchers write in the journal Leukemia Research.

They stressed that there is not enough information to make cancer treatment decisions based on geriatric assessment scores. It's also not clear if the assessments benefit patients going forward.

"Do geriatric assessments result in a better quality of life or a different outcome with cancer? No one has done a randomized clinical trial to answer that question yet because it is very complicated," Klepin said.

The researchers suggest that geriatric assessments can play a role in cancer patient care and well being, but more research on the subject is needed.

"Geriatric assessments are a way of taking into account social, cognitive and physical function, as well as pharmacological concerns. (They) assess multiple health issues all at once," Klepin said.

"There is no question that as a doctor, I will be better prepared to help my patient the more I know about them."

SOURCE: http://bit.ly/1dc4iqJ Leukemia Research, online January 16, 2014.

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