More older patients with both acute and chronic forms of leukemia are being treated at M. D. Anderson every year. Dr. Elihu H. Estey, professor in the Department of Leukemia, says some of them do well with aggressive chemotherapy and achieve either complete or partial remissions.

“But we have found that many patients above 80 do not easily tolerate or respond favorably to anti-cancer drugs. Since the incidence of most leukemias increases with age, our challenge is to select the subsets of patients who can be managed well even though they may not go into full remission. We have several great examples of patients past 80 who continue enjoying active lives,” Dr. Estey explains.

Like surgical patients, individuals considered for and receiving chemotherapy for all types of cancer are assessed in the Medical Specialties Center, whose clinicians collaborate closely with treating physicians to measure toxicity to the heart, lungs and kidneys. This center also provides evaluation of patients with infectious diseases.

In general, radiation treatments do not cause as many serious side effects as chemotherapy in the elderly. A recent two-year report showed several 90-plus patients received radiation, with the oldest being 100 years.

“Treating the elderly with radiation doesn’t differ a lot from younger patients. It is their physiologic age — not the calendar — that we appraise. No matter what age, we strive to offer therapy that is curative,” says Dr. James D. Cox, head of the Division of Radiation Oncology and holder of the Hubert L. and Olive Stringer Distinguished Chair in Oncology.

With more older patients being treated at M. D. Anderson, the Department of Symptom Control and Palliative Care continues expanding its comprehensive services to evaluate each elderly patient’s quality of life. Even when aggressive treatments are not recommended, controlling pain and other health-robbing problems can help many of them.

Department Chair Dr. Eduardo Bruera notes that the elderly represent the most rapidly increasing segment of society and that cancer incidence will keep rising as the population ages, so older patients with cancer will continue posing complex challenges that take into account many factors.

“Our expectations for elderly patients must consider such issues as any underlying medical problems, the potential side effects from cancer therapy and the availability of family members or other supportive caregivers in their homes or the communities where they live. For patients whose cancers are not being actively treated, our overriding goal is to help them maintain maximum physical and psychosocial functions for as long as possible,” says Dr. Bruera, who holds the Frank T. McGraw Memorial Chair in the Treatment of Cancer.

His clinical research focusing on the effects of advanced cancer on seniors is starting to yield data that should lead to understanding how better to control pain, fatigue, malnutrition and mental confusion. Minimizing those common symptoms “can go a long way toward giving the elderly the highest quality of whatever time they have,” Dr. Bruera says.