For some years now, there has been a debate raging about whether cancer treatment needs to be tailored according to the patient’s age.
There has been no clear indication until now on whether people with cancer should be treated differently depending on their age. A new research program at the Ohio State University has now begun adjusting their protocol for cancer treatment based on a person’s biological age. But does cancer treatment really depend on your age? Let’s find out.
Cancer Treatment and Your Biological Age
A program started by The Ohio State University Comprehensive Cancer Center in collaboration with the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute is focusing on assessing the mental and physical fitness of elderly cancer patients and tweaking their treatment protocol accordingly.(1) Known as the FITNESS study, the project has been designed to see if the overall physical and mental well-being and fitness of older cancer patients have any effect on clinical outcomes.(2) The premise of the study is that a person’s biological age is not the same as their chronological age.(3,4) Our chronological age is the number of years that have passed since we were born, while our biological age is a reference to how old the cells in our body really are and, therefore, taken as an indication of our real age.(5)
While your chronological age is irreversible and not dependent on your lifestyle and habits, your biological age may keep on varying depending on your lifestyle, including factors such as diet, exercise, attitude, sleep, stress levels, etc.(6)
Depending on the biological age, a 70-year-old person could be as well and healthy as a 50-year-old, and a 50-year-old could be as frail and weak as someone who is 80.
Cancer Treatment in Older and Younger Patients
People who are over the age of 65 years and have cancer are more likely to need special care and treatment as compared to those who are younger and have cancer. They require much more medications as compared to younger patients, and due to this, there is a higher possibility for drug interactions.(7,8)
Older patients are also more likely to develop frailty, which is a type of ailment that leads to weakness, loss of skeletal muscles, and increased vulnerability to permanent disability. Frailty, in turn, severely impacts their ability to go through chemotherapy.(9,10)
Cognitive issues are also a concern with older cancer patients. Doctors feel apprehensive in treating cancer in older people with aggressive chemotherapy due to the side effect of significant cognitive impairment.
At the same time, older cancer patients also require more physical, practical, and psychological support while undergoing treatment, including needing someone to take them to and fro for their treatment sessions. These factors are usually non-existent for younger patients, allowing doctors to attempt aggressive treatments with them.
Looking at the FITNESS Study
The FITNESS study focused on prescribing cancer treatment based on a person’s biological age, instead of chronological age. It was carried out by The Cancer and Aging Resiliency (CARE) Clinic at the Ohio State University. It was primarily designed to look at how to better meet the needs of older people with cancer.(11)
The FITNESS study is focused on older adults who had lung and blood cancers. To date, the study has dealt with 27 patients and has a goal to accrue 50 patients in the future.
Previous studies carried out by the same clinic involved looking at chemotherapy toxicity in older people with cancer.(12)
In the FITNESS study, the elderly patients were carefully followed to assess side effects throughout the cancer treatment. The aim of the study is to understand the side effects of cancer treatment in older patients better. With the advent of many new therapies, the question remains as to how older cancer patients will tolerate and respond to these methods.
The study also focused on factors such as whether a patient is able to take the prescribed medications on their own, or they need assistance. How well a person is able to function and what type of support system they need around them while undergoing cancer treatment was also looked at.
The learnings from this study will help doctors personalize cancer care according to age and help them adapt basic geriatric treatment principles as part of the standard routine for all patient care.
Conclusion
The FITNESS project and research study has put the focus back on a hotly debated topic – that of whether cancer treatment needs to be customized as per the age of the patient. The research holds the promise of changing several medical protocols on how to take care of geriatric cancer patients. However, further research is still needed to actually establish these findings and make them a part of standard treatment routine.
- Cancer.osu.edu. 2020. [online] Available at: <https://cancer.osu.edu/blog/vietnam-veteran-now-helping-ohio-state-doctors-improve-lung-cancer-treatment> [Accessed 14 July 2020].
- Cancer.osu.edu. 2020. [online] Available at: <https://cancer.osu.edu/> [Accessed 14 July 2020].
- Levine, M.E., 2013. Modeling the rate of senescence: can estimated biological age predict mortality more accurately than chronological age?.
- Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 68(6), pp.667-674.
- Mitnitski, A.B., Graham, J.E., Mogilner, A.J. and Rockwood, K., 2002. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC geriatrics, 2(1), pp.1-8.
- Beunen, G., Ostyn, M., Simons, J., Renson, R. and Van Gerven, D., 1981. Chronological and biological age as related to physical fitness in boys 12 to 19 years. Annals of Human Biology, 8(4), pp.321-331.
- Wahlin, Å., MacDonald, S.W., de Frias, C.M., Nilsson, L.G. and Dixon, R.A., 2006. How do health and biological age influence chronological age and sex differences in cognitive aging: moderating, mediating, or both?. Psychology and aging, 21(2), p.318.
- Scripture, C.D. and Figg, W.D., 2006. Drug interactions in cancer therapy. Nature Reviews Cancer, 6(7), pp.546-558.
- Riechelmann, R.P., Tannock, I.F., Wang, L., Saad, E.D., Taback, N.A. and Krzyzanowska, M.K., 2007. Potential drug interactions and duplicate prescriptions among cancer patients. Journal of the National Cancer Institute, 99(8), pp.592-600.
- Ethun, C.G., Bilen, M.A., Jani, A.B., Maithel, S.K., Ogan, K. and Master, V.A., 2017. Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology. CA: a cancer journal for clinicians, 67(5), pp.362-377.
- Baijal, P. and Periyakoil, V., 2014. Understanding frailty in cancer patients. The Cancer Journal, 20(5), pp.358-366.
- Cancer.osu.edu. 2020. [online] Available at: <https://cancer.osu.edu/patient-support/support-during-treatment/cancer-and-aging-resiliency-clinic> [Accessed 14 July 2020].
- Hurria, A., Togawa, K., Mohile, S.G., Owusu, C., Klepin, H.D., Gross, C.P., Lichtman, S.M., Gajra, A., Bhatia, S., Katheria, V. and Klapper, S., 2011. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Journal of Clinical Oncology, 29(25), p.3457.
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