NEVER TOO OLD FOR CHEMO

THE OLD RUSTY MAIL

An e-journal for old people

Russell Burton, an Old Person

I ran across this article in the December 2014 issue of the journal Scientific American.  Even though the title does suggest some nasty thoughts, my take was quite the opposite.  No doubt age especially old age does limit us as to our medical options.  I understand that when a person reaches the age of 80 organ transplants are no longer available.  Now this restriction may change as the population as a whole ages.  In a way I hope so because at my age of 82 soon to become 83 I feel like a major medical option which could save my life has suddenly disappeared.  In a way one of my life boats has been cut adrift.

In fact this article reports exactly that age-limitation are changing with us old people in regards to aggressive medical treatments such as chemo therapy.  Simply physicians are attempting more aggressive treatments on old people with advanced cancer.  And why not for Americans are living longer lives.  I read the other day that half of the babies born now will live to be 100!  For me that is not hard to believe for when I was a young person my hope was to live to see the turn of the century.  In the late thirties and early forties life expectancy was 68 years old and being born in 1932 to see 2000 arrive was not a sure thing.

Of course now, life expectancy is something like 78 for men and 81 for women so in 100 years yes it could well be 100 years of age.  Life expectancy of course means that half of a population will reach that age.

This article had a different take on this increased aging thing using cancer as an example.  Now, half of all cancer patients are older than 65 and by 2030 70% over 65 will get cancer.  That is the increase in old cancer patients will have increased by 40% in just 15 years. Three reasons were given why old people have so much cancer: 1 – we have accumulated more exposure to things that cause cancer, 2 – old cells are more vulnerable to cancer and 3 – our immune system which is our primary biological cancer fighter is slowing down.

Not surprising most clinical medical research is done on younger people so how well old people will respond or even tolerate aggressive treatments are not known. Apparently, this situation is changing as medical research studies are beginning to include old people.  This mind set is not surprising as it is just common sense that old people are supposed to die. Well not so fast…

Finally, physicians are beginning to understand that all old people are not alike, that is chronologic age is not as good an evaluator of well being as what is known as physiologic age.  Yes, physiologic age differs greatly among old people.  And, I might be one of those lucky ones who is ‘aging’ slower than many old persons.  I say that because of the following experience I had a few years ago when I had major surgery on my leg which I have written about before in this blog.

I was examined by a young anesthesiologist resident a few days before my surgery to get a handle on my physiologic age although she did not call it that.  Still she wanted to know how old I was other than being in my late 70s.  You know ‘was I going to die on the operating table’?

To begin when she entered my room she exclaimed “You are 78?” asking in a voice exalting amazement. She was even more dumfounded when she learned I had all of my original teeth and I was taking only two meds each day. Simply, she had discovered my physiologic age not my chronologic age and she was astonished.  Clearly, she had not been around very many old people.

On the other hand my geriatric physician understands physiologic aging although she never gave it that name.  The other day she mentioned to me that I was in very good health.  Then she let me know that many of her patients are in terrible health.  Clearly the bar I had just crossed was not very high.

In this article I mentioned earlier, physicians have attempted to measure this physiologic age thing using a Comprehensive Geriatric Assessment.  This measurement takes into account a patient’s strengths and weaknesses which include such things as chronic diseases, medications, cognitive abilities, nutritional status, social support and probably most importantly the ability to perform ‘activities of daily living’. 

Now, we all know what the last assessment includes thus revealing how multiple biologic systems are working together. Now understanding that is a measure of a person’s health which of course is a predictor of how well a person will tolerate the rigors of an aggressive medical treatment. A specific assessment chart has been devised just for patients who need chemo therapy and involves 11 specific questions with a resulting risk score of 0-100.  A high score of course suggest a less aggressive treatment is in order.

Of course age enters into the meaning of this score as a young person might care to undergo aggressive treatment because they potentially have many more years to live than an old person.  Certainly ‘quality of life’ means a great deal to an old person with not much life left to live. You know enjoy those years while you can rather than suffering through aggressive medical treatments just to gain a few months of being sick.

Still old people may want to take the side effects of an aggressive chemo therapy as documented in this article.  The author’s father-in-law who was 91 decided to give it a go which included 35 radiation treatments but after 20 months he is a survivor.  And, at 93 he is doing quite well.  I am not sure I would have taken his route.

Certainly as the article concludes ‘…having lived many years in no way disqualifies you from gunning for more time’.  I could not agree more!!!!!

11/14

PS: I am now nearly 85 years old and in those 2 years I have aged considerably. That is my physical capabilities are more limiting and I have poorer balance all of which compromises my ‘activities of daily living’. So, regarding this article I am beginning to understand what it means to be ‘too old for chemo’.