Cancer at all ages

Author: Laurie Wertich

There is never a good time for cancer. It’s an unexpected hurdle that can afect young people, older people, and everyone in between. “Cancer disrupts everyone’s life, no matter what age they are when they are diagnosed,” explains Julie Smith, RN, director of care management at Cancer Treatment Centers of America (CTCA) in Goodyear, Arizona.

Although the disease is an equal opportunity illness—serving as the ultimate disruption—it can affect people differently at different stages of life. In fact, when it comes to cancer, age is an important consideration. It can be a key factor in terms of choosing a treatment approach, and it can carry its own unique range of emotional and psychosocial issues.

What's age got to do with it?

So what exactly does age have to do with cancer? A lot, actually. From a strictly medical standpoint, younger patients may tolerate more-aggressive treatment better than older patients. Older patients may have other co-existing conditions that affect the treatment plan. The side effects of treatment may be more debilitating in older individuals. “Take a side effect like fatigue, for example,” explains Smith. “It can affect patients of all ages but in different ways.”

There are emotional and psychosocial aspects, as well. A 20-year-old patient faces different issues than does a 60-yearold patient. Some patients are concerned about dating, others with career and fertility, and others with retirement.

“Here at CTCA we treat the whole person, not just the cancer or symptoms,” explains Smith. “When we start to educate and treat a patient, we have to look at where they are in their life and address the issues that are relevant.”

Cancer at all ages - it's different but the same

Teens

Teens with cancer fall into a health care gap. In fact, Catherine Blotner, a 17-yearold with a grade 2 oligodendroglioma, says, “We're not quite young children anymore, but we aren’t fully adults either. Teenagers typically tend to be either the oldest or the youngest patient in the waiting room and can sometimes be stuck in health care limbo.”

This limbo serves only to exacerbate the sense of isolation that many teens with cancer feel. Catherine explains that one of the many challenges of having cancer at her age is the loss of ability to relate to peers. “When you’re diagnosed with cancer, it’s not like you can turn to your friends and expect them to have an immediate understanding of the situation,” she says.

What’s more, cancer can interfere with rites of passage, such as high school graduation or learning to drive, and coming-of-age activities, such as dating and hanging out with friends. And of course concerns about appearance can be damaging to a teenager’s self-image. Overarching all the impacts that cancer has on the lives of teens can be a profound sense of loss and a necessary revision of plans and dreams. “High school and college students diagnosed with cancer have to reevaluate their goals and accept the loss of abilities and dreams, whether physical, mental, or emotional,” Catherine says. “Some of the long-term side effects of chemo and radiation include vision, hearing, and memory difficulties; and entering the workforce with the ‘new you’ requires a reassessment of goals and career choices.”

On the clinical side, treatment decisions can also be complicated by the fact that teens straddle the pediatric and adult realms. “The question is, ‘Where does the cutoff from pediatrics start?’” explains Richard Shildt, MD, a medical oncologist at CTCA in Goodyear, Arizona.

And yet determining treatment for teen patients includes considerations that adults may not face. For instance, one of the challenges of treating teens is being aggressive enough to cure the cancer but cautious enough to avoid long-term side effects or second cancers later in life. In Catherine’s case, for example, one potential treatment option is surgery, but it carries the risk of affecting her speech and language abilities. “Any type of treatment carries significant risk, especially surgery, but sometimes you have to take the risk now for future gains,” she says.

Young adults

Patients in their twenties and thirties also face a variety of unique issues related to treatment and life. “Younger patients have a much longer life expectancy, so we try to be as aggressive as we can for a cure. They can tolerate it,” Dr. Shildt explains. “On the flip side, we have to be careful with long-term toxicity. They’re going to live 30 to 60 more years and could have delayed problems.” For example, chemotherapy can affect the bone marrow and lead to leukemia later in life, and radiation early in life can lead to breast cancer later. As a result, long-term toxicity is one of the major concerns for younger patients.

But there are other big concerns, as well. “Fertility is very important to think about during the young adult years,” Smith explains. Fertility concerns can affect treatment choices; for example, women who want to remain fertile cannot have radiation to the pelvis. Prior to treatment, some women may choose to harvest eggs, and most men are encouraged to bank sperm. “A young lady can go through chemotherapy and have a normal child later in life,” explains Dr. Shildt. “On the other hand, testicles, which produce sperm, are much more sensitive to chemotherapy than are ovaries. The older a patient becomes, the more sensitive to cancer treatment the reproductive organs become.”

Beyond fertility, cancer can affect a young person’s day-to-day life in drastic ways. Dating, attending college, studying, and being social may take a backseat to cancer. The fatigue associated with cancer treatment can be debilitating and have a huge impact on school, work, and social life—just at the time when peers are charging ahead with all these aspects of life. Suddenly, working long hours, staying out late, or having a drink with friends can be both unrealistic and detrimental to treatment.

In addition to these psychosocial considerations, the physical changes brought on by surgery can present an additional significant challenge. “Body image can be affected significantly in this age group,” Smith says. “Changes such as hair loss, feeding tubes, and ports can be very traumatic, especially when a patient is dating. It can really affect their social life.”

The family years

Individuals in the family years—which span the twenties, thirties, and forties, depending on where someone is in life— may still face fertility concerns, but there will be other issues as well. “The biggest disruption for people at this stage of life is with work and family life,” explains Smith.

In fact, this stage of life is often a balancing act, with or without cancer; the cancer diagnosis simply adds to the challenge. Smith says that cancer during this stage of life can cause a big financial strain because these are the years when most people are focused on building their careers. Many people are already strapped with trying to raise a family, and some patients are faced with the prospect of taking time off from work.

Todd Gillett was diagnosed with malignant synovial cell sarcoma in his early thirties and can attest to the challenges of juggling work, family, and cancer. Todd owns an insurance agency and has two children who were ages seven and nine at the time of the diagnosis. He was busy growing his business and coaching his son’s basketball team before the diagnosis— but everything changed quickly.

“In the middle of my first chemotherapy cycle, I was sitting there with my laptop, trying to solve a problem at the office and communicate with the assistant coach of my son’s basketball team,” Todd recalls. “A nurse finally grabbed me and said, ‘You’ve got to stop and focus on beating this. All that stuff will be there when you get back.’”

Todd realized right away that she was right. “You have to prioritize. Your first priority is to beat the disease,” he says. “My main goal was that I was not going to let these kids grow up without their dad.” Todd says that the hardest part of having cancer at this stage in life was trying to raise children and run a business—and realizing that he needed to take six months off just to fight the cancer. “I basically turned everything off and just dealt with the financial blow that was coming as a result,” he says.

Smith says it is imperative for cancer patients in this stage of life to get support. They may need help with childcare or maintaining the household or they may need financial assistance or time off from work.

Middle age

Everybody ages differently, and while some older adults are healthy and vital, others may have co-existing conditions such as heart disease. According to Smith, these comorbidities can make side effects worse and even limit some treatment options. What’s more, cancer treatment can often exacerbate the symptoms of menopause that many women in their fifties experience.

“These patients may not be as healthy as when they were younger,” Dr. Shildt explains. “We have to be careful with dosing because they may not tolerate chemotherapy as well as younger patients do.” Older adults also face a variety of psychosocial and practical issues related to coping with cancer. Some are retired and on a fixed income, and cancer can make a dent in their nest egg. Others feel alone because their children are grown and living far away.

On the flip side, in some cases older adults are uniquely positioned to cope with cancer—their children are grown and they are still healthy and independent. Vee Spencer, a special events developer and corporate sponsor consultant, was in her midforties when she was diagnosed with stage II breast cancer. Her daughter was just finishing high school, and Vee was at a solid point in her career where she could take time off and do what she needed to do. “I feel like at that age I was better equipped to deal with cancer,” Vee explains. “I didn’t have small children; I was extremely able bodied; I was financially sound. I could focus on nothing but battling the cancer. I would say that this is the prime of my life and the prime time when I could do battle with cancer.”

Older age

For older patients the main issue is striking a balance between aggressiveness of treatment and life expectancy. “We have to determine how aggressively to treat the cancer in the context of how many years we think they’re going to live,” explains Dr. Shildt. “There is no specific age cutoff. We have to look at the individual—some are as healthy as a 50- or 60-year-old, and others are frail.”

Irene Goodwin was diagnosed with breast cancer at age 70 and colorectal cancer in her late seventies. “I had a positive attitude. I just knew I was going to be cured,” says the now-83-year-old from Tarboro, North Carolina. After undergoing a mastectomy, she was cancer-free until the colorectal cancer diagnosis many years later.

Irene faced some challenges with treatment— at one point her weight dipped as low as 84 pounds, which meant she was not a candidate for surgery. She also still suffers some long-term effects from radiation. But Irene is a fighter. “If you’re going to have treatment, just make up your mind that you’re going to cope with it and do the best you can,” she suggests.

Cancer at any age

Cancer at any age is a disruption, but the aspects of a patient’s life that are most affected may differ depending on age and stage in life. For young adults the disruption may affect school or career. For someone in the family years, the impact is on the family unit, work life, and child care. For older adults the disruption may hit finances most significantly. Ultimately, while age isn’t everything, it can be a significant factor when it comes to cancer and its treatment. By honoring a patient’s stage of life, we can optimize treatment and quality of life.

Your browser (Internet Explorer 7) is out of date. Learn how to update your browser.