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Why Older Adults with Cancer Need a DIFFERENT Treatment Approach [Deep Dive into Pancreatic Cancer]
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Jun 10, 2025
In this video, the hosts discuss a real-world case study that highlights the issues of providing cancer care to older adults. They emphasize how **patient involvement** and **holistic care** can improve cancer treatment. The insights from various sources showcase how **geriatric oncology**, along with **comprehensive care**, can positively impact **cancer in the elderly**. Connect with me via LinkedIn https://www.linkedin.com/in/arminshahrokni?utm_source=share&utm_campaign=share_via&utm_content=profile&utm_medium=android_app X https://x.com/GeriOncologist?t=QMpM6F9KTB9_2W66OiEOzw&s=09 Instagram https://www.instagram.com/aging_cancer/profilecard/?igsh=MXI3eTBieTNhNjJucg== Google Scholar https://scholar.google.com/scholar?hl=en&as_sdt=0%2C33&q=armin+shahrokni+&btnG= Also, please like and share the video and subscribe to the channel
View Video Transcript
0:04
here we go diving deep into the sources
0:07
you've shared with us yeah let's get
0:09
into it today we're unpacking a really
0:11
compelling case study it uh it gets
0:13
right to the heart of a major challenge
0:15
in medicine today tailoring complex
0:18
cancer care especially you know for
0:20
older adults absolutely and what these
0:22
sources really show I think is this
0:24
powerful insight for older adults facing
0:27
something serious like cancer success
0:29
often depends less on just well
0:31
targeting the disease itself and more on
0:34
understanding and really actively
0:35
supporting the whole person that's the
0:37
core idea we're exploring we're looking
0:38
at the case of a 78-year-old woman uh
0:41
we'll call her Eleanor okay and she
0:43
received a pretty tough
0:45
diagnosis locally advanced pancreatic
0:47
adnocarcinoma pancreatic cancer is
0:50
always challenging and locally advanced
0:52
means well it's grown into critical
0:54
nearby areas yeah surgery upfront not
0:56
really an option and the sources they
0:59
lay out the dilemma right away how do
1:01
doctors balance these potent maybe life
1:03
extending treatments like intensive
1:06
chemo with the unique vulnerabilities
1:09
the health complexities that can come
1:10
with age and you know past medical
1:12
issues and the chemo they initially
1:14
looked at for Eleanor was ML fulfarnox
1:18
right which the sources say is very
1:20
effective for this cancer type but
1:22
notoriously difficult hard to tolerate
1:25
very hard and that's where this crucial
1:26
tool comes in introduced in the sources
1:30
the comprehensive geriatric assessment
1:32
the CGA the CGA think of it like putting
1:34
on a different lens it forces you to
1:36
look beyond just the tumor beyond the
1:37
standard lab tests to build a really
1:40
complete picture of the individual their
1:42
health their function their whole life
1:44
situation so our mission then in this
1:46
deep dive walk through Eleanor's
1:48
situation understand what that CGA
1:50
uncovered for her specifically and see
1:54
exactly how those findings reshaped her
1:56
treatment plan how it went from maybe a
1:58
standard protocol to something truly
2:00
personalized centered on her exactly so
2:03
let's maybe start by understanding the
2:05
journey that brought Eleanor to this
2:07
point what the material you shared tells
2:10
us okay it began maybe surprisingly not
2:13
with obvious cancer symptoms but with a
2:15
fall the fall right and then came the
2:17
more telltale signs like jaundice that
2:19
yellowing of the skin and eyes and
2:21
abdominal pain investigations then
2:23
quickly found the mass in her pancreas
2:26
and from there things got complicated
2:28
the material details how the tumor
2:30
caused a blockage needed a stent right
2:32
but then she developed a severe
2:33
gallbladder issue a serious infection
2:36
and this wasn't just a quick hospital
2:37
visit she ended up in the ICU needed a
2:39
ventilator and then required pretty
2:42
extensive rehab afterwards just to get
2:44
her strength back wow so by the time she
2:46
is stable enough for the oncology
2:47
consult her cancer was confirmed as
2:50
locally advanced kind of wrapped around
2:51
major blood vessels and a key cancer
2:54
marker CA19 to9 it was rising active
2:57
disease okay so given how aggressive it
3:00
looked and its local extent the initial
3:03
recommendation from her oncology team
3:04
was that intensive Mulfurinox
3:07
chemotherapy right the goal as the
3:09
sources outline it was to try and shrink
3:11
the tumor maybe enough for surgery later
3:14
or at the very least control its growth
3:16
and this is where the geriatric
3:18
oncologist Dr miller enters the picture
3:21
and the comprehensive geriatric
3:22
assessment the CGA becomes well not just
3:25
an option but really a necessity
3:28
absolutely the sources really emphasize
3:30
that this assessment it asks questions
3:32
looks at details that frankly a standard
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oncology workup just doesn't capture it
3:37
goes deeper it has to it's recognizing
3:40
that Eleanor isn't just you know a
3:42
pancreatic cancer diagnosis she's a
3:44
78-year-old woman with a unique health
3:46
profile shaped by her life her medical
3:48
history and all of that is going to
3:50
profoundly impact how she handles a
3:52
really demanding treatment like Emma
3:54
Fulfox okay so let's dig into what the
3:56
CGA actually found for Elellanar first
3:58
up functional status her ability to
4:01
handle daily activities right now the
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sources say she was actually remarkably
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independent in many ways even walking 45
4:08
minutes a day outside with a cane which
4:10
is pretty impressive especially after
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everything she'd just been through her
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overall performance status was still
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ECOG 1 ambulatory could do light work
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yeah by UT and this is where the CGA
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gets crucial
4:24
it also picked up on new limitations
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things that had changed since her
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illness okay like what difficulty
4:30
bathing herself needing help with
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housework even some trouble initially
4:35
with self-feeding ah okay so subtle
4:39
signs maybe of a recent decline
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potential vulnerability even with that
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walking exactly and beyond just her
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current function the assessment reviewed
4:48
her co-orbidities all the other chronic
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health stuff she was managing right the
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full picture she had a history of
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sarcoidosis affecting her lungs high
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blood pressure asthma and uh a seizure
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disorder she was on medication for and
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these aren't just you know items on a
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list each one represents an organ system
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that could potentially be stressed or
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affected by chemotherapy increasing
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risks absolutely increasing the risk of
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complications or just making management
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during treatment much more complex her
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cognition was also looked at now while
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she seemed sharp during the appointments
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the assessment captured that history of
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encphylopathy that sort of brain
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dysfunction confusion during her ICU
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stay and also noted a tendency
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occasionally to have trouble recalling
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names and that historical vulnerability
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that's important it raises a flag you
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know her brain might be more susceptible
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to chemlated cognitive changes
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chemobrain people call it or even acute
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delirium during treatment which can
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really impact independence and recovery
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severely nutritional status was
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highlighted as a major concern big red
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flag here okay she'd lost over 10 lbs in
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6 months was getting full really quickly
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when eating early satiety had a low
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appetite and her albumin level that
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protein marker in the blood linked to
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nutrition was a bit low yeah poor
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nutrition is a huge predictor of poor
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outcomes with chemo and increased
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toxicity if your body isn't fueled
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properly it can't cope it just can't
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repair the damage from treatment
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effectively increases risk of side
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effects hospitalizations this finding
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alone is significant and polyfarm
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pharmacy meaning being on multiple
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medications she was taking about 12
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different regular prescriptions wow 12
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that's incredibly common in older adults
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but also incredibly risky when you're
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adding powerful new drugs like
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chemotherapy into the mix interaction
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huge risk of drug interactions side
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effects that might get confused with
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cheotoxicity or the cancer itself and
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just the challenge of managing that many
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pills correctly a pharmacist review is
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basically non-negotiable there the CGA
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also looked at her social support
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network this is interesting crucial yeah
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she lived alone felt loved by her family
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but the sources noted she had limited
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practical help available for things like
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chores if she were feeling sick right
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who's actually there dayto-day exactly
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she was also less social than before and
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had concerns about getting to
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appointments transportation and managing
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finances during her illness and this is
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absolutely critical who is there to help
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if she's wiped out from chemo or really
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nauseous how does she get to potentially
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frequent clinic visits living alone
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living alone limited practical support
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it significantly bumps up the risk of
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complications being managed poorly at
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home or just the whole logistical burden
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becoming too much then the assessment
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specifically looked for geriatric
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syndromes general vulnerabilities okay
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and the sources pointed out clear signs
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of frailty developing her recent severe
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illness the deconditioning that needed
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rehab right the loss of reserve
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persistent fatigue the weight loss we
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mentioned and her history of falls all
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painting a picture and frailty isn't
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just feeling old it's a recognized
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medical state decreased physiological
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reserve when someone's frail even
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standard doses of powerful treatments
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are much more likely to just overwhelm
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their system leading to cascading
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problems functional decline it's a
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strong predictor of who won't tolerate
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intensive therapy well and here's where
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the CGA delivered a really stark finding
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the sources really emphasize this one
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using a specific tool the CG score ah
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yes the chemotherapy risk assessment
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scale for high age patients right it
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predicts chemo risk based on some of
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these factors a previous assessment for
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Eleanor predicted an almost 90% risk of
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severe chemotherapy side effects 90%
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just let that sink in 90 that's huge it
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means going forward with standard
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intensive empulronox had well a near
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certainty of causing major potentially
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life-threatening toxicity for Eleanor
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that single data point pulled from
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looking at her whole picture it
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fundamentally changes the risk benefit
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discussion so putting it all together
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Mhm you have this woman with a serious
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aggressive cancer needs potent treatment
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and she's clearly resil resilient
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motivated she came through that awful
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illness already she's definitely
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resilient but the CGA reveals the full
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depth of her vulnerability significant
9:08
frailty markers the nutritional issues
9:10
that history of complex illness and
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confusion the polyfarm pharmacy limited
9:15
practical support and that almost
9:16
guaranteed high risk of severe harm from
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the standard chemo approach so the
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dilemma is acute emperor offers the best
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shot against the cancer itself but the
9:25
risk of it just overwhelming her leading
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to terrible side effects long hospital
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stays maybe irreversible loss of her
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independence
9:34
that risk was incredibly high based on
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this comprehensive picture and what's so
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fascinating I think is that Dr miller's
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assessment the CGA it didn't just lead
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to saying no to treatment right it
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wasn't just stop no instead it provided
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this detailed road for how to tailor the
9:50
treatment how to build in robust support
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to make some level of therapy
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potentially possible and safer for her
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okay so let's unpack those tailored
9:58
recommendations the ones that came
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directly out of the CGA findings first
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the modified chemotherapy approach right
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so the plan as the sources detail it
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acknowledged Empolarox was the pertinent
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option needed but and this is key
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strongly advise proactive dose
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reductions from the very first cycle not
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waiting for problems exactly not waiting
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to see if she got sick it was
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anticipating that near 90% risk and
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starting lower potentially significantly
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lower doses of all the drugs in that
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combo right from the beginning and
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recognizing her vulnerability to low
10:29
blood counts using medication growth
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factor support to boost white cells from
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day one preventatively absolutely
10:37
essential given that high predicted
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toxicity okay and crucially the
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recommendation also included having a
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very low threshold to switch gears to
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move to a gentler chemo regimen if she
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showed signs of struggling so
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flexibility built in yes and the sources
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frame this perfectly I think not as
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giving up or failure but as smart
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adaptation based on her individual
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tolerance and keeping the focus on
11:00
quality of life and they also explicitly
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mentioned considering her living
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situation being alone when thinking
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about treatment intensity they did
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recognizing the challenge of managing
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potentially severe side effects without
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immediate help right there at home so
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the social assessment directly informed
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the clinical safety decisions precisely
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it's all connected okay so beyond
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tweaking the chemo itself there was this
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huge emphasis on wraparound supportive
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care massive yeah the CGA didn't just
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change the drug plan it triggered this
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whole multi-prong support strategy and
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the supportive care presented as being
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just as important as the chemotherapy
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itself what did it include aggressive
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nutritional support was top of the list
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getting a dietitian deeply involved to
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tackle the weight loss the poor appetite
11:48
that early fullness because you can't
11:50
tolerate chemo without fuel exactly you
11:53
need the building blocks then continued
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rehabilitation physical therapy wasn't
11:58
just general exercise no it was targeted
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specifically at rebuilding the strength
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and balance she lost after her big
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illness and directly addressing
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functional issues the CGA found like her
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difficulty bathing connecting the dots
12:11
back directly medication management was
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key to a full pharmacist review of those
12:16
12 meds simplify check interactions
12:19
ensure safety alongside the chemo makes
12:21
sense cognitive monitoring was
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recommended keeping a close eye for any
12:25
signs of confusion cognitive changes
12:27
during treatment given her history in
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the ICU and the social support piece
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wasn't just noted it was acted on right
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connecting her with social work to
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tackle those practical concerns
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transportation potential financial
12:39
strain exploring options for maybe
12:41
getting some inhome help if her needs
12:43
increase down the line so all these
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different elements identified by the
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CGA they created this necessary safety
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net really around the medical treatment
12:54
absolutely acknowledging that her
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success wasn't just about the drug
12:57
killing cancer cells it was about her
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entire system's ability to withstand the
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process maintain function stay out of
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the hospital if possible and throughout
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all of this the sources stressed the
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importance of shared decision-making
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critically important having those
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continuous open conversations with
13:15
Eleanor herself about her goals yeah
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what mattered most to her was it pushing
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for every possible extra week or month
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even with major side effects or was it
13:25
about maintaining her quality of life
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her independence even if that meant a
13:29
less aggressive approach and ensuring
13:30
she really understood that given her
13:32
high risks that the CGA brought to light
13:35
the primary objective for the team kind
13:37
of shifted towards controlling the
13:38
cancer yes but vigorously preserving her
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quality of life and function not
13:43
necessarily aiming for that maybe low
13:45
probability surgical cure at extreme
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cost it's about aligning the patients
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priorities with the clinical reality
13:51
that the assessment revealed making sure
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everyone's on the same page about what
13:55
success looks like in her specific
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situation and the plan involved Dr
14:00
miller staying closely involved working
14:02
alongside the main oncology team ready
14:05
to adjust things as needed based on how
14:07
Eleanor actually responded in this case
14:09
as your sources laid out it's just such
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a powerful illustration of the bigger
14:13
picture here how so it shows so clearly
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that for complex patients particularly
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older adults with cancer a
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one-sizefits-all approach isn't just
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like suboptimal it can be actively
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harmful a deep holistic assessment like
14:27
the CGA isn't some optional add-on it's
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fundamental it's essential for making
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wise compassionate decisions it's about
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moving beyond just protocols based on
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you know disease type or age group right
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and truly centering care on the
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individual their strengths their
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vulnerabilities their values it requires
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balancing the incredible power of modern
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treatments with well clinical wisdom and
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really robust support systems and the
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CGA provides that essential framework to
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see the whole person and then build a
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treatment strategy that respects all
14:57
that complexity so bringing it back to
15:00
the listener
15:01
why does this level of detail this whole
15:03
story matter to you well Alanor's story
15:05
really underscores that medical
15:07
decisions are deeply personal especially
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when you're dealing with multiple health
15:10
factors or challenges like she was m it
15:13
highlights that your overall health your
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support network how you're really
15:17
managing at home dayto-day and what your
15:19
priorities are all of that is absolutely
15:22
critical information your healthare team
15:25
needs it to give you the best possible
15:27
care tailored to you so based on what
15:29
we've seen in these sources maybe a key
15:30
takeaway is be an active participant in
15:33
your healthcare conversation absolutely
15:35
don't hesitate to share the real details
15:37
how you're really feeling your energy
15:39
your appetite any difficulties at home
15:41
who helps you out all of it and ask ask
15:44
your doctors your nurses about all the
15:46
kinds of support that might be available
15:48
beyond just the pills or the chemo
15:51
things like nutritionists physical
15:53
therapy social work yeah tap into those
15:56
resources they're often there okay so
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final thought here the sources show us
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this incredible level of detailed
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individual assessment needed just for
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Eleanor's complex case it's a lot of
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work yeah what does this tell us about
16:09
how medicine is evolving and maybe maybe
16:12
about how we should even define success
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when we're treating complex illnesses is
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success only about shrinking a tumor on
16:19
a scan or is it about helping someone
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navigate a really tough illness while
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preserving their ability to live the
16:25
life they value it really makes you
16:27
think about well the full picture
16:30
[Music]
#Aging & Geriatrics
#Cancer