Shahid Akhter, editor, ETHealthworld spoke to Dr Trinanjan Basu, consultant radiation oncologist, HCG Apex Cancer Centre, Mumbai, to know more about trends and challenges in Geriatric Oncology.
How does cancer treatment impact the quality of life?
Quality of life besides the treatment of cancer is also equally important, if we look back it used to be only treatment about 10- 20 years back where cancer itself used to be a word with people used to doom them and people used to only consider that let them get rid of the disease without considering the quality of life. Now life does not mean only number of years, even if somebody has 4 y ears 5 years to live with dignity and more importantly to maintain their activities of daily living is equally important. So, vis-à-vis the technology as it advances in radiation oncology, these quality of life issues also came up very prominently, so as the people start considering them to be as an endpoint of treatment indicator, thats how the quality of life changed over the years, how their activities of daily living being impacted while on the treatment in short course and as well as in the long course.
We used to have simpler technologies so we could not do a lot to give a good quality of life because this is also important while we treat on the surrounding normal structures. It means how much radiation dose they are receiving and how these doses are impacting on the normal functioning of those structures. As we advance in technology with intensity modulated therapy, image-guided radiotherapy, so on and so forth, we can pretty well spare the normal structures or rather keep their radiation doses to tolerance limit so that their functions in the short term as well as in the long-term can be maintained to their fullest. It means they will have some side effects but then they will come back to their normalcy in a temporal fashion. So, then globally as well as in India, people started looking into the quality of life issues so that these people even if they are rid of the cancer they can come back to the normal activities of daily life and they maintain their jobs and they can earn the bread and butter for the life again, once they get rid of the dreaded disease.
How is HCG bringing a difference in Geriatric Oncology scenario?
So, in HCG, what we are trying to do to is to concentrate specifically on the geriatric population in terms of quality of life in cancer care. Now, the standard international definition for geriatric population is someone who is 75 years and above. Now as we improve in diagnostics and screening, the age has become just a number now. It does not mean that a person of 75 years, will be actually behaving like a 75-year-old, what we used to think about, because there is a difference between the chronological age and the biological age of a person. So, a 75-year-old can be as fit and active as a 50-year-old also.
Now, the aging population also is increasing globally, we will see more of people surviving beyond 75, beyond 80, may be beyond 85 years as well. There is a recent India aging report in 2017, which states that currently we have about 12 to 15% of more than 75 years aged population and it is going to be around 20% by 2050. So, we really need to look into themselves more clearly and carefully. Because as the people will live, as WHO has also predicted by 2025 we will have 1 in 5 persons living with cancer (some sort of) so we are definitely going to see a geriatric population beyond 70 who is diagnosed with malignancies.
Now this is a very unique cohort in terms of that the geriatric population have their own issues in daily quality of life. Maybe they are not bothered about the cancer, maybe they are not aware of the cancer, what bother them may be a very minor issue like going to the temple daily, going to the market daily, maintaining their daily evening chat with their friends. Maybe some people already have their compromised bladder and bowel functions to maintain their urinary habit, their bowel habit, maybe they need to change diapers frequently, so these issues are very prominent to them.
In the last year we have treated about 15 to 20 odd geriatric population group and there are 5 or 6 of them who are actually touching 90 and you won’t realize if they don’t disclose their age. They are very fit, active and healthy. They are diagnosed with cancer because they have some trouble in their food pipe while eating because most of them are of the head & neck region or upper gastrointestinal tract malignancies. So, we need to do something for them, just because of that, we cannot say that ok you are done with a number of years because they are healthy, they are happy and they want to lead a good quality of life. So we treated them, while treating them we realized while on the long course treatment also maybe for 3 weeks to 5 weeks, they are actually not bothered with the treatment-related symptoms, they want people to talk to them, they have their issues like there is a gentleman of 89 years old who used to daily go for a morning walk then used to have his cup of tea and then sit with 5 of his friends and chat and that became troublesome because his voice started reducing, the intensity and the clarity of the voice. So, that was the alarming factor for him. They actually need someone to talk to them at length.
In Indian OPD scenarios where you have 5 to 10 patients waiting outside your consulting chamber, it actually becomes difficult for a particular physician or a particular person to talk at length. So, in HCG what we trying to do in geriatric oncology OPD is to have a comprehensive multidisciplinary approach where not only physicians write, may be surgeons, radiation oncologist and medical oncologist, we also need psychological nurse maybe a psychological Counsellor and nurse dedicated to take care of elderly patient’s issue and to talk to them at length and actually to discover what bothers them most and then to take forward vis-à-vis their treatment of the primary disease.
Everything comes with challenges, the challenges are not only in terms of manpower or the setup, we also need a wider visibility to take care of geriatric oncology because some people still might feel they are done with their number of years on this earth so why to give so much of importance. Like we give a lot of importance to paediatric population because they are at the beginning of their life, diagnosed with the dreaded disease and they have a number of years to survive more if treated accurately. But the same holds for geriatric again and again to reemphasize it is not only number of years which matters, it is the quality of those years how they spend actually matters more.
Personally I am trying to collaborate with an international geriatric radiation oncology group, they are basically US based and they actually help in giving funds and collaborate with the Indian scenario patients so that is how in a multidisciplinary and global scenario we can take care of this patient in a much more accurate fashion and here by ‘accurate’ I mean getting more paramedical staff, more of support staff, so that the actual issues which these patients are facing can come up directly and we can take care of them in a better way.
We do have isolated data to support also that these patients tolerate well, there are a couple of Indian Studies, I do personally a part of an already published data on the elderly head & neck cancer patients who are treated with chemo radiotherapy. So, in advanced head & neck cancer we need treatment where radiation and chemotherapy both are needed. Looking forward we will try to carry out more of those research and clinical data and try and collaborate with Local, National and International bodies to come out with solution which are actually needed for this group of patients.