A cancer diagnosis is difficult at any age, but older patients often face unique challenges: an increased risk of drug reactions, coping with other health conditions, increased financial burdens of care, and sometimes the stress of being a caregiver to a spouse or loved one. Memorial Sloan Kettering Cancer Center (MSK) is committed to providing older cancer patients with the treatment, facilities, and support they need.
With this goal in mind, MSK offers services through the Cancer and Aging Interprofessional Team. This team includes oncologists, geriatricians (internists who specialize in the care of older adults), geriatric nurse practitioners, nurses, social workers, geriatric nutritionists, psychiatrists, geriatric pharmacists, and members of both the Rehabilitation Department (Physical Therapy and Occupational Therapy) and the Supportive Care Service.
Patients often have health conditions in addition to their cancer that require special attention and extra care. They may be receiving treatment from multiple doctors and need someone to provide a comprehensive evaluation to minimize the risk for avoidable complications.
Our geriatric physicians and nurse practitioners consult with MSK oncologists to help determine how well a patient may tolerate a specific cancer therapy and assess what precautions may need to be taken during treatment. Our geriatricians are experts in the subtleties of how older patients respond to cancer treatments and can perceive symptoms of other medical conditions that are present or may develop. They also consult with patients who have finished their cancer treatments but still need follow-up care.
The Geriatrics Service is available to both inpatients and outpatients at MSK. Patients who would like a geriatric specialist involved in their care should ask their MSK doctor or nurse for a referral.
A clinical pharmacist can evaluate an individual patient’s medication needs to simplify the regimens, ensure that prescribed medications are taken according to a doctor’s instructions, and are as appropriate, effective, and safe as possible. The pharmacist creates a medication regimen that won’t interfere with the goals of therapy or contribute to excessive disability, loss of independence, or decreased quality of life.
The Cancer and Aging Social Work Program offers service-based psychosocial counseling and support that seeks to improve each participating patient’s quality of life. To do this, our social workers help older patients adjust to the difficulties associated with illness and assist them as they cope with the effects of the normal aging process. Older patients may be at an increased risk of social isolation due to circumstances such as living alone or acting as the primary caregiver for a spouse. Social workers provide supportive counseling, cognitive and behavioral strategies, and problem-solving techniques through individual, couples, and family sessions.
Those who may also benefit from the Social Work Program’s services include older patients who do not have other available means of support; older patients who may be experiencing some measure of psychological distress such as depression or anxiety; and adult children who are caring for parents with cancer.
In addition, the Cancer and Aging Social Work Program provides consultations and information on aging and cancer-related issues for patients, caregivers, staff, and the MSK community through educational lectures and supportive seminars. Topics discussed at our Educational Lecture Series include exercise, cancer and the older patient, and spirituality. To obtain information on these upcoming events, please contact the Resources for Life After Cancer program at 646-888-8106.
For more information about the Social Work Program at MSK, patients can contact Social Work at 212-639-7020, visit the Social Work Support page, or speak to their MSK doctor or nurse. For more information on Caregiver Services, visit their webpage.
The Cancer and Aging Rehabilitation Program at MSK has occupational and physical therapists who specialize in treating older patients. The therapists’ combined goals are to maintain and improve the ability of patients to move and function independently as they prepare to leave the hospital.
Occupational therapists address the basic activities of daily living, such as dressing, grooming, toileting, and bathing, as well as responsibilities like handling finances, managing medications, and shopping. The therapist also evaluates and treats cognitive changes, such as memory, attention, and vision, and helps patients maintain their independence through environmental modifications, compensatory strategies, and procedures that optimize safety.
Physical therapists help patients with a variety of musculoskeletal, neuromuscular, and cardiopulmonary issues achieve the highest possible level of functional independence. The therapist evaluates each patient and designs an individualized treatment plan that will help restore and maintain range of motion, diminish pain, increase endurance, and enhance safety awareness. The therapist and patient work closely together to ensure that the patient’s personal goals are part of the treatment plan.
Emotional Support for Older Adult Patients and Their Caregivers
A cancer diagnosis is a stressful experience. For older adults, it may be just one of many stressors — they’re managing other medical problems, retirement may be impacting their financial situation, and the loss of family members and friends may be more frequent. Being diagnosed with cancer may feel overwhelming.
The Department of Psychiatry and Behavioral Sciences provides specialized services for older adults and their loved ones to help manage the difficult emotions that can come with having cancer. Providers in this program are available to patients during their hospital stay as well as on an outpatient basis. They are experienced in identifying various sources of distress that are often associated with diagnosis, disease recurrence, nonresponse to cancer treatment, side effects from cancer treatments, and the changes that occur with a cancer diagnosis later in life. Providers can also give referrals to other mental health specialists, within MSK or externally, to assist in longer-term counseling needs.
Counseling is open to individuals, couples, or families. Group sessions are also available for patients or family members who might benefit from working with others in similar circumstances. Psychiatrists can prescribe medication when needed to address more severe issues.
Nutrition plays an integral role in many aspects of cancer care, including symptom management and recovery. Older adults may be at risk for vitamin and mineral deficiencies that affect nutrition status and warrant therapeutic restrictions and medical nutrition therapy.
The Cancer and Aging team provides a dietitian to outpatients, free of cost. The services include initial nutrition counseling, nutrition education, and follow-up assessments. Patients are most often counseled on weight management, diabetes education, symptom management, and special diets.
Nutrition counseling sessions — which may be conducted in person or via phone consultation — provide a review of a patient’s diet history, including a discussion of how often the patient eats, changes in weight and appetite, supplement use, and side effects of treatment. Nutrition education covers both regular and special diet restrictions. Additionally, patients learn about managing symptoms related to cancer and its treatment, such as weight loss or gain, loss of appetite, and the safety and usefulness of dietary supplements. Follow-up assessments provide feedback on nutrition status and progress toward nutrition goals as a result of the counseling and education.