Introduction
Cancer is a chronic disease with a high burden among geriatric patients in the UK and across the globe. Cancer incidence among people older than 65 is expected to rise by 67% from 2010 to 2030 (Flannery et al., 2021, p.2150). Given that most people within this age group are retired with hopes of relaxing at home, a cancer diagnosis is often devastating. It causes physical and emotional stress to individuals already dealing with health challenges emanating from advanced age.
Worse still, pharmaceutical interventions may have a poor prognosis due to a weakened immune system (Kadambi et al., 2020; Nipp et al., 2019). For instance, even over-the-counter medications such as aspirin increase the risk to geriatric patients (Guo et al., 2021). Although cancer is a burdensome illness, oncologists can help improve the patient’s quality of life through person-centered care and multidisciplinary teamwork.
The search utilized the Medline database to select specific, evidence-based articles that explored the topic. Medline has a wide range of peer-reviewed and scientific papers (Purssell and McCrae, 2020). Two search terms, “cancer” and “older adults,” were used because they provided sufficient literature on the problem. Using the Medline database, which contains a diverse range of sources, is crucial for increasing the depth of findings (Rebar and Macnee, 2022). Moreover, it offers several journals that are continually updated to provide deep and broader perspectives on healthcare subjects.
Limiters to English papers published within the last five years were used to refine the search (Pawlik, T.M., & Sosa, 2020). The inclusion criteria for choosing the sources included primary research written in English and published within the last five years. However, the book chapters, systematic reviews, meta-analyses, and expert opinions were excluded from the study. This paper aims to explore the existing literature on cancer in older adults.
Discussion of Selected Articles
Barriers and facilitators to participation in exercise prehabilitation before cancer surgery for older adults with frailty: a qualitative study by Barnes, K. et. al. 2023
The article highlights the factors that promote and discourage exercise participation among geriatric patients. The participants stated that home-based exercise offers numerous benefits, including gaining control over their health and experiencing positive psychological rewards. Physical inactivity and sedentary lifestyles are associated with increased mortality rates (Várnai et al., 2022).
Therefore, it is evident that the patient’s effort to maintain physical activity has a positive impact on the outcome. The study aimed to identify barriers and facilitators of exercise for cancer patients over 65 years who had just completed their pre-rehabilitation. They utilized the social constructivist approach, which explains changes in health-related behavior as a guide in monitoring changes in the study participants.
The researchers employed a descriptive, qualitative study within a single center, utilizing a parallel-arm, randomized controlled trial design. The inclusion criteria for their sample of 15 included individuals who had undergone elective cancer surgery within 3 weeks of data collection, were over 60 years old, and were involved in some form of aerobics (Barnes et al., 2023). Particularly, the sample was based on information power and narrowing study aims, and was satisfied after 12 interviews.
However, they decided to add three more and determine if it would result in additional information. Notably, surgical considerations for this population should always consider oncologic prognostication, functional assessment, risk stratification, and functional assessment (Korc-Grodzicki et al., 2019). Healthcare providers should thoroughly explore the patient’s condition before recommending any physical activities or other treatment modalities.
The study’s findings reveal a lack of strong evidence to support the efficacy of interventions in enhancing functional recovery after surgery for all participants. Nonetheless, a significant positive impact was observed among participants who adhered to the program (+76 m, 95% CI 30-122) (Barnes et al., 2023). The schedule should be manageable and tailored to meet the specific needs of the geriatric population.
Moreover, giving the participants a sense of autonomy and finding intrinsic motivation by making the routine enjoyable (Barnes et al., 2023) is vital. However, most were discouraged by fatigue, weather, guilt, and frustration following failure to follow the routine. Similarly, a different study found that senior citizens who undergo surgery as part of their cancer treatment recover faster when engaging in fitness activities at their residences (McIsaac et al., 2022). There should be sufficient resources to support the engagement, and they should receive encouragement from others.
The implication for patients is to remain vigilant and stay active during surgery to remove tumors. Furthermore, the study demonstrates that healthcare staff and their organizations should tailor physical activities to meet the specific needs of each patient. The study by Li et al. (2021) concurs that assessing the patient’s condition and determining toxicity before recommending any exercise is essential.
The duration, such as a fixed 12-week Multimodal schedule, of physical fitness is essential in helping the body to adjust (Mikkelsen et al., 2022). The recommendation is for future studies to consider enhancing psychological support and modification of aerobics (Barnes et al., 2023). The other suggestion is for researchers to replicate this study using a wider sample and quantitative methodology.
Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults with Cancer by Ryan D. N. et. al., 2020
Oncologists often experience some challenges trying to manage geriatric patients with incurable types of cancer. Cancer often results in emotional stress from pain, exhaustion with medication, and loss (Pearce et al., 2022; Ritchie et al., 2022). Further, older adults with cancer can undergo financial toxicity due to the high medical costs of treatment (Arastu et al., 2020).
Patients may worry about many things, including the probability of using some cancer as the cause of their diagnosis (Kantor et al., 2020). Oncologists can focus on the medical aspect, treatment, and drug prescription, as well as psycho-emotional services (Rossi et al., 2021). Therefore, doctors need to work with a team of other professionals when managing their patients.
The objective of this study was to determine the feasibility of transdisciplinary interventions targeting specific needs, including comorbidity, physical function, and palliative care. One of the problems that individuals with a cancer diagnosis have is anxiety about the future and the afterlife (Trevino et al., 2020). In such cases, the oncologist may need to work with a psychologist and religious experts to help manage the emotions and spirituality of their client. The interest of many researchers in the topic indicates a gap in practice.
In the study, Patients at least 65 years old were randomly assigned to usual care or transdisciplinary intervention. The sample consisted of 62 patients, whose baseline data were collected in February 2017, and subsequent data were collected in June 2018 (Ryan et al., 2018). The primary focus of the assessment was the quality of life, communication confidence, and general cancer therapy functional assessment symptoms. The researchers then calculated the mean change score, gauging that 0.2, 0.5, and 0.8 from the baseline to 12 weeks indicate small, medium, and significant impact, respectively (Ryan et al., 2020). More than 75% of the participants completed the survey and all the study visits.
The enrollment rate for the period was 55.9%, as most patients reported being too ill to participate in the study. The median age of the participants was 72.3 years, of which 56.5% suffered from gastrointestinal cancer, while 43.5% from lung cancer (Ryan et al., 2020). The number of participants who attended the first visit was 82.1%, while those who attended both visits were 79.6%, resulting in an overall completion rate of 89.7% among patients.
Findings indicate “intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58)” (Ryan et al., 2021). Failure to provide holistic care can lead to accelerated aging and poor prognosis (Sedrak et al., 2021). The cancer patient may have reduced cognitive function, which various professionals must resolve (Magnuson et al., 2021; Rentscher et al., 2021). The study’s implication for nurses is that they should work together. It is vital to recognize that the patient may feel lonely and isolated and needs that extend beyond the physical. Moreover, the researchers highlight the need for interventions targeting geriatric-specific and palliative care.
Conclusion
The two studies have shown that senior patients with cancer experience significant challenges. The healthcare team should personalize their treatment and help them with exercise (Barnes et al., 2023). Older adults with cancer are often frail and at increased risk of depression and other emotional disturbances (Gilmore et al., 2021). Moreover, their body are likely to be weak due to diminishing body functions. Physical activity benefits the body, as well as social and emotional well-being, leading to an improved quality of life (Mok et al., 2021).
The other study suggests that it is essential for individuals with diverse work backgrounds to collaborate in managing this population (Ryan et al., 2020). The implication for practice is the implementation of multidisciplinary teamwork and customizing exercise routines to suit the patient’s condition. It is vital to focus on the complex combination of psychosocial and medical issues that combine geriatricians and outpatient oncology care. The patient can subscribe to all services at once and enjoy the benefits of transdisciplinary care without incurring additional costs each time they see a specialist. The other implication is to include a wide range of exercise activities, such as dance, yoga, gymnastics, and walking paths, allowing the patient to choose the one that is most enjoyable and meets their needs.
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