Compliance to cancer treatment among elderly: Hospital USM experience

 

Biswa Mohan Biswal.MBBS.MD.DNB.FAMM

Clinical Oncologist, Hospital Universiti Sains Malaysia

 

 

Management of elderly patients with cancer is a big challenge to practicing oncologists in the developing countries. The age distribution of adult patient population is predominantly young, while elderly patients accounts for less than 20% of population. According to health care priority, geriatrics do not comes as important health concern, thus the care of elderly is not specialized, rather adopted as per adult oncology management. As there are no strict guidelines of management for elderly, most patients in geriatric age group receive similar treatment alike adults. They get same radiotherapy fractionation and chemotherapy drug schedule. Cytotoxic chemotherapy treatment invariably results in higher toxicity, leading to treatment discontinuation and low compliance to therapy. Elderly patients have dysfunctional end-organs, low cardiac reserve, senile organ system and altered psychology with different meaning of life compared to elderly in the west. The management of elderly patients in Malaysia is influenced by caretaking children’s wish, personal preference to receive traditional treatment over conventional western medicine, financial status, and availability of oncology facility in the vicinity of home and transport to the hospital. Furthermore, the facility for palliative care, supportive care service, and home care system is meager or non-existent. Therefore compliance to cancer treatment is greatly influenced, leading to treatment discontinuance and low survival. University Science Malaysia is strategically located in the northern peninsular Malaysia caters for three costal states. We conducted one retrospective analysis of 400 cancer patients with age more than 60 years from our oncology records. The cancers sites were lungs, breast, colon, nasopharynx and other miscellaneous sites. These patients were managed with cancer surgery, radiation, chemotherapy, palliative and supportive care. The compliance to above cancer management was affected due to treatment related toxicity, non-adherence to follow up, uncontrolled traditional & complimentary therapy, lack of family support, and financial constraints. Our experience showed extensive gap in the management of elderly which need multidisciplinary approach with medical and nonmedical personnel along with good social support. Special funds should be allocated for the geriatric cancer patients for their specific needs.