Researchers strive to improve cancer care for older patients

At the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, UNC Lineberger researchers led by Hyman B. Muss, MD, presented preliminary findings from several studies focused on older adults with cancer.

University of North Carolina Lineberger Comprehensive Cancer Center researchers are working to improve the care of patients 65 years and older—a group that makes up 60 percent of newly diagnosed cancers in the United States. As the overall population ages, that number is expected to grow.

At the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, UNC Lineberger researchers presented preliminary findings from several studies focused on older adults with cancer. These studies ranged from efforts to assess systematically patients’ fitness for chemotherapy treatment, to investigations of interventions designed to improve patients’ function and strength.

“Cancer in the United States right now is a disease of aging, and the average age of getting cancer is 67,” said the studies’ senior author Hyman B. Muss, MD, director of the UNC Lineberger Geriatric Oncology program and the Mary Jones Hudson Distinguished Professor in Geriatric Oncology in the UNC School of Medicine. “Our goal is to improve care for older people by tailoring treatment to the disease as well as to the goals of each patient.”

Here are a few study highlights:

  • To gauge whether treatments for breast cancer may be prematurely aging patients’ immune systems, researchers studied levels of a biomarker called p16. Expression of this marker inside cells has been linked to aging. They compared p16 expression in peripheral blood T-cells for 70 early-stage breast cancer patients who had received two types of chemotherapy: anthracycline versus non-anthracycline treatments. They found patients who received anthracycline-based treatments had a two-fold increased expression of p16, while for patients who had non-anthracycline treatment, p16 expression increased 1.2-fold. Those changes are equivalent to biologic aging of an additional 11 and six years, respectively, the researchers report, which might have “major consequences” on survival. “Chemotherapy has been a major step forward in the treatment of breast cancer, improving the cure rate, but what we found is that certain types of chemotherapy age you more than some of the newer regimens,” Muss said.
  • Surveying 55 patients above age 65 to see if they can dress themselves, go shopping, among other factors, researchers identified patients who had limitations in their function to determine if they should receive an intervention. Patients with limitations were randomly assigned to receive occupational therapy, physical therapy to address strength and endurance issues, or a brochure about other services. From the study, they found occupational and physical therapy significantly improved patients’ mental health compared with the brochure.
  • Researchers studied whether a scoring system called the Chemotherapy Toxicity Risk Score could predict which patients would experience serious side effects from chemotherapy. Ultimately, they hope to better determine which patients should receive standard or reduced chemotherapy based on their risk for side effects.

In the study, researchers calculated risk for side effects for 44 patients. They found physicians’ choices aligned only modestly with the scores in terms of their chemotherapy choices.  Among patients who ended up receiving standard, rather than reduced treatment, and who had a high-risk toxicity score, there was a 70 percent incidence of high-grade adverse events and hospitalizations.

“Caring for older people with cancer is challenging because there can be a wide variability in their general health, aside from the cancer,” Muss said. “You have 70 year olds who work every day and are in great shape, and you have people who are frailer. This is one example of multiple studies we have underway into ways to improve patient assessment.”