Geriatric oncology – are we overlooking the underlying complications of ageing?
Cancer is the leading cause of death worldwide, only second to cardiovascular disease. It is a disease, which can affect anyone; it doesn’t care if you are young or old, male or female. The number of new cases reported each year is increasing, and this is partly due to our growing and ageing global population. Now things sound bad, but fortunately because of continually improving cancer treatments, long-term prognosis is better than ever for many survivors and people are living longer with cancer. Although cancer can affect anyone, it is generally considered a disease of older adults. Indeed, around 50% of cancer survivors are aged over 70 years old.
Recently I read an interesting article discussing “geriatric oncology”. In this article, the author, a clinical oncologist discusses how encountering older cancer survivors (>75 yrs) has become routine, and alongside dealing with their treatment, patients also struggle with underlying comorbidities associated with their age. This brings up some interesting thoughts. First, we often forget that whilst cancer survivors are dealing with the side effects of treatment such as fatigue, loss of muscle strength and reduced exercise tolerance, many are also suffering from underlying comorbidities, which predate the cancer diagnosis. Often assessing and optimising the patients’ health will be forgotten whilst undergoing treatment. Patients are often outpatients, and once cancer treatment has been delivered, they are sent on their way. In addition, some older adults may be unsuitable for treatment due to frailty and/or comorbidities highlighting a need for alternative therapies for these individuals to optimise health and maintain quality of life.
This idea of geriatric oncology is interesting given the plethora of issues older adults experience in response to ageing. These issues have come to mind recently as I have been writing a review article with my CATCH ITN colleague Louise Brennan and supervisor Brian Caulfield, looking at the use of NMES to optimise healthy ageing. During the preparation of this article, delving into the ageing literature, it’s clear there are many disabling physiological and functional changes, which accompany the ageing process. Sarcopenia, a hallmark of the ageing involves the progressive loss of muscle mass and strength and can be seen in as many as 50% of older adults, negatively impacting on physical function and independence. Now, sarcopenia can be linked both directly and indirectly to periods of inactivity. Objectively collected data suggests only around 5% of this population may be engaging in recommended levels of exercise. However, aggressive cancer treatments are also associated with muscle and strength loss, albeit through different mechanisms. However, I believe in order to effectively treat cancer survivors we must put more consideration into their underlying conditions also, which when combined with treatment side effects could lead to catastrophic reductions in function and health.
In the exercise and ageing literature, unfortunately the frail or geriatric sarcopenic populations are underrepresented with most studies involving healthy older adults. This makes it difficult to develop evidence-based interventions for these groups. Now, to link this all back to my current research area, NMES holds promise, particularly in these older, frail groups who struggle to exercise. NMES has been shown to target some of these physiological and functional changes; NMES can target muscle strength and hypertrophy by increasing Type II muscle fibre size (fast fibres required for force generation) and number, can improve muscle quality, and can also improve aerobic exercise capacity. In my research I hope to provide evidence of the benefits of this technology in this group who more often than not struggle to exercise. Hopefully we can demonstrate NMES to be an effective alternative to voluntary exercise, which may act as a bridge back into voluntary exercise programmes, and make everyday task easier.
More consideration must be given to the underlying conditions, which the older adult cancer survivor may be experiencing alongside the treatment side effects. By acknowledging these issues, we can develop more efficacious treatments to help optimise health and quality of life.