Why People of Different

Ages Need Different

Cancer Treatments
A new program at The Ohio State University is
adjusting cancer treatments based on a person’s
biological age.
Older adults undergoing cancer treatments can face different obstacles
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than younger adults. Getty Images

Laird “Smitty” Smith is in treatment for stage 3 lung cancer.

At 72 years old, he also walks every day, plays golf twice a week, and
mows his own yard.

Smitty is being treated by Dr. Carolyn Presley, a thoracic medical oncologist

at The Ohio State University Comprehensive Cancer Center (OSUCCC)–
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

He’s also enrolled in the FITNESS study, a project designed to assess the

physical and mental fitness of older cancer patients and the effect that may
have on clinical outcomes.

“Biologic age does not equal chronological age,” Presley told Healthline. “A
70-year-old could be as healthy as a 50-year-old and a 50-year-old can be
as frail as someone who is 80. Age is not necessarily telling the whole
story.”
Older vs. younger cancer
patients
Jamie Fertal, DO, is medical director of the Outpatient Palliative Care
Clinic,The Center for Cancer Prevention and Treatment at St. Joseph
Hospital in California.

Among her specialties are palliative care and geriatrics.

Fertal told Healthline that people over 65 have unique problems and needs
compared to those who are younger.

“They’re typically on far more medications than their younger counterparts,

so there’s more possibility for drug interactions,” she said.

“Many older patients start to develop frailty, which is a syndrome that

includes weakness and loss of skeletal muscle and susceptibility to
disability. And you can certainly imagine how that would affect the ability to
withstand chemotherapy,” she added.

Cognitive issues also need to be considered.

“Significant cognitive impairment would be a deterrent to treat with

aggressive chemotherapies. The strict compliance required can be a
challenge with cognitive impairment,” said Fertal.

She explained that older patients typically need more physical,

psychological, and practical support, such as rides to treatment.

“Many of these factors are sort of taken for granted with younger patients,”
said Fertal.

The FITNESS study

 Dr. Carolyn Presley, a thoracic medical oncologist who is part of the
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FITNESS study. Photo courtesy of The Ohio State University

The Cancer and Aging Resiliency (CARE) Clinic at The Ohio State

University is designed to meet the needs of older adults with cancer.

The clinic recommends treatment based on “biological age” rather than

chronological age.

Presley said the FITNESS study is open to older adults with lung and blood
cancers, noting there may be a stigma associated with “geriatric”
assessment.

So far, the study has accrued 27 patients, with a goal of 50.

Presley explained that prior studies have involved in-depth geriatric

assessment but only before treatment started.

In the FITNESS study, participants are followed closely for side effects and
geriatric assessment throughout the course of treatment.

“We want to understand side effects better. We have a lot of newer

treatments and we don’t know how older adults will tolerate and respond to
them,” she said.

The geriatric assessment is a comprehensive visit.

“We’re really looking to see how the patient is functioning,” said Presley.
“Can they still take care of themselves? How’s their mobility and nutrition?
Are they vulnerable or fit? Can they tolerate treatment?”

It’s important to know if a patient is able to take medications as prescribed

on their own or if they would need assistance.
“Treatment itself can involve taking a pill. And every treatment relies on
taking other medications for things like nausea, diarrhea, constipation.
Sometimes lifestyle changes are involved,” said Presley.

That’s why it’s important to understand how well a person functions and
what type of support system they have around them.

“We also do blood and stool tests to check the microbiome bacteria that live
in the gut. We think there’s a link between the types of bacteria in the gut
and how you’ll respond to immunotherapy and what the side effects might
be,” said Presley.

She noted that research has shown that when you ask about specific
symptoms and treat them, people can actually live longer, even if you don’t
change anything about their cancer care.

“I ask all my patients, regardless of age. Function is what we’re focusing on.
And we have a symptom monitoring program for FITNESS age criteria 60
and older,” she said.

Presley said it’s something that could be done in routine practice, even if it’s
not part of a study.

“Our clinical team learned a lot from this study and will probably apply basic
geriatric principles as part of routine care for all patients. It’s about
personalizing cancer care. It’s patient-centered care,” she continued.

Presley believes doctors need more time with their patients.

“I do think patients on this study get more time with the research
coordinator. They ask detailed questions about how they’re feeling. We’re
asking, so they tell us. We don’t know if they would otherwise,” she said.

The goal, said Presley, is to keep patients living the life they want to live
during cancer treatment.
“Smitty is one of the healthiest patients. He’s done exceptionally well,” she
said.

Vietnam veteran beating cancer

Laird “Smitty” Smith has responded well to his personalized treatment for
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lung cancer. Photo courtesy of The Ohio State University.

Smith learned he had cancer in September 2018 after seeking treatment for
hip pain.

Cancer in the lung had reached surrounding lymph nodes and the
esophagus.

A Vietnam veteran, Smith told Healthline he had been exposed to Agent

Orange, a known carcinogen.

Initial treatment included five months of chemotherapy and radiation

therapy, as well as surgery to remove part of this left lung.

“I’m breathing better now,” he said, still working at his desk.

Through it all, Smith continued in his career as a building manager.

He still goes to the OSUCCC–James once every two weeks for

chemotherapy. It’s a regimen he will continue for two years.

“It’s a lighter type of chemo to make sure the cancer doesn’t come back. I’m
wiped out for a couple of days, then I’m fine until next time. I don’t lift heavy
things anymore. I don’t go as fast as I used to, but I still keep up a good
pace,” he said.

His daily walk, once 9 to 11 miles, is now down to 6.

Smith calls the FITNESS program “amazing.”

He believes state of mind plays an important role, too.

“When I found out about the cancer, I knew nothing would ever be as hard
as Vietnam. If you have something in life you went through, you mentally
think in your mind, ‘OK, I got through that. I can get through this.’ You can
still keep positive even if you can’t do some stuff you used to be able to do,”
he said.

As of this week, Smith is retiring, at least for now. But that doesn’t mean
he’ll be taking it easy.

He’ll start by painting the interior of his house. It’s the first item on the
“honey do” list.