Elderly cancer patients in good mental and emotional health are likely to have a better prognosis or chance of recovery from cancer than those who are not, according to a recent study by the National Cancer Centre Singapore (NCCS).
Depression was one of six factors identified as having a direct impact on the survival rate of elderly Asian cancer patients. The study, reported in the Journal of Clinical Oncology (20 Sep 2011) was carried out on 249 elderly patients who were attending the oncology clinic at NCCS.
“We conduct screening tests for our elderly cancer patients as part of the Comprehensive Geriatric Assessment (CGA). The CGA analyses six factors that could predict the overall survival rate of elderly cancer patients,” says Dr Ravindran Kanesvaran, one of the study’s researchers and Associate Consultant at the Medical Oncology Department, NCCS.
If the elderly cancer patients show signs of depression – detectable in their negative moods and feelings, loss of appetite and sleep, or loss of interest in life – they are referred to a psychiatrist for a thorough evaluation of their psychological state before recommending treatment, Dr Kanesvaran adds.
Other factors affecting the elderly’s cancer survival rate
Besides depression, the study identified five other factors that could affect elderly cancer patients’ survival rate:
- Stage of cancer
Elderly cancer patients with advanced cancer (stages III and IV) have a poorer prognosis.
- Abnormal albumin levels (indicator of severe malnutrition)
Low albumin (protein) levels in the blood, evident from the swelling of the body, usually indicate worsening of the disease and a poorer prognosis. Proper nutrition and intravenous albumin supplementation may temporarily raise albumin levels.
- Cognitive impairment (e.g. dementia)
Elderly cancer patients who are cognitively impaired have a poorer prognosis than those who are not. Dementia can affect a patient’s compliance to treatment.
- Co-morbidity (existence of one or two additional diseases)
Elderly cancer patients, who suffer from diseases in addition to cancer, are found to have a worse cancer survival rate than those who are only battling cancer.
- Poor ECOG status (defined as Eastern Cooperative Oncology Group performance status or functional capacity for daily living)
Elderly cancer patients, who are able to perform normal daily activities independently, have a significantly better survival rate than those who are totally dependent on others.
Tips on improving cancer survival rates
- Provide a supportive home environment
Create a loving and supportive home environment for elderly cancer patients suffering from depression. Ensure they take the prescribed depression medications and do not live in social isolation. Caregivers should take time to listen to and talk with the elderly patient.
- Ensure proper nutrition
The loss of teeth coupled with difficulties in chewing and swallowing, as well as a loss of appetite, taste and smell caused by cancer treatments, will affect the ability of elderly cancer patients to maintain good nutritional health.
Prepare frequent, but small and well-balanced meals, to make eating more manageable. Include soft foods and healthy smoothies made of yogurt, fruits or vegetables to make swallowing easier for elderly cancer patients.
- Take an active role in the treatment process
Elderly cancer patients with severe cognitive impairment, such as dementia, are totally dependent on their caregivers to make the “right” treatment decisions. They are less able to articulate the symptoms of the disease or treatment side effects, and need help to follow through with the treatment schedule.
Caregivers should learn about possible treatment toxicities and provide elderly cancer patients with emotional and physical support throughout the treatment period.
- Ensure elderly cancer patients get regular exercise
Encourage elderly cancer patients with difficulties in performing normal daily activities to exercise regularly or seek physical rehabilitation to improve their strength and mobility. Cancer patients who exercise have better survival rates.
“Caring for elderly cancer patients can be very challenging. While it is important for caregivers to have patience, compassion and understanding, it is equally important to avoid caregiver burnout. Caregivers should give themselves respite from constant care-giving,” Dr Kanesvaran advises.