Geriatric Challenges: Age shouldn’t determine treatment, experts say

The University of Pittsburgh’s Dr. Eibling, who specializes in head and neck surgery, said that what patients really want is to be able to go home again. “On an almost daily basis, we ask ourselves not, ‘Is this patient too old for surgery?’ but, ‘Will this patient be able to be rehabilitated after surgery?’”

When dealing with cancers of the head and neck, there’s another wrinkle: Although some cancers can be treated through non-surgical means, such as radiation or chemotherapy, some older patients may not be good candidates for these alternatives. “If an elderly patient has significant kidney or renal disease, they’re actually not a candidate for chemotherapy, because the chemotherapy would shut down their kidneys,” said Marilene B. Wang, MD, professor of head and neck surgery at the UCLA David Geffen School of Medicine in Los Angeles. “Surgery may be a better option then. So we do need to look at the complete picture.”

In some cases, Dr. Wang and her colleagues have even had patients undergo a coronary bypass or angioplasty to optimize a heart condition before proceeding with a cancer surgery. A multidisciplinary tumor board can be a particularly helpful guide for otolaryngologists. At these meetings, surgeons, radiation oncologists, psychologists, social workers, and other providers can offer their own perspectives about the benefits and risks of different interventions for specific patients. Collectively, Dr. Wang said, these specialists can decide upon the best course of treatment.

Resources

Choosing the best path forward requires clear guidance. Fortunately, otolaryngologists can call upon an expanding range of tools to help them decide on the best course of action for older patients. Multiple otolaryngologists, for example, have contributed to a free e-book, Geriatric Care Otolaryngology (entnet.org). The eight-chapter document, made available through the American Academy of Otolaryngology-Head and Neck Surgery, covers everything from age-related hearing loss to facial plastic surgery.

Meanwhile, the American Geriatric Society (AGS) has devoted a portion of its website and a section of its annual meeting to specialists like head and neck surgeons. The society has also helped to fund a free and largely Internet-based geriatric otolaryngology curriculum established by Emory University (http://otolaryngology.emory.edu).

Finally, the AGS is developing a set of geriatric competencies for surgeons, through a consortium of American Board of Medical Specialties surgical boards. Dr. Johns said the guidelines will help drive residency education, board certification, continuing medical education and maintenance of certification.