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  • Addressing the needs of older cancer patients

    Bill Gurney with his oncologist Charles Fuchs, MD, MPH, and longtime life partner Mary Kay LoweBill Gurney with his oncologist Charles Fuchs, MD, MPH, and longtime life partner Mary Kay Lowe 

    The front-desk facilitator saw the patient's birth date on her screen - June 27, 1908 - and for a moment wondered if there was a mistake. Then she glanced up at the stately gentleman standing before her.

    The appointment was his, and so was the birthday.

    Even in an era when advanced treatment approaches allow more patients than ever to live with and beyond cancer, Bill Gurney is unique.

    With his 102nd birthday coming up next month, the Cape Cod resident and colon cancer survivor is quite possibly the oldest person ever treated at Dana-Farber.

    "I'm flattered," Gurney said with a laugh when informed of his "oldest patient" status during a recent appointment.

    Asked the secret to his longevity, even in the wake of a serious illness, he explained: "There is an old song that goes 'A sunny disposish is all that you can wish.' That's my motto. I'm not a worrier."

    Gurney is, however, in excellent physical health overall, which his Dana-Farber oncologist Charles Fuchs, MD, MPH, says is a key for any older cancer patient.

    The centenarian still does a combined 50 push-ups and sit-ups every day, and hopes to get back to golfing this summer after a two-year hiatus. A retired attorney who graduated from Yale in 1930, he is a shade under 6 feet tall and weighs about 170 pounds, roughly the same weight he was as a pilot during World War II.

    Given these facts, Fuchs felt comfortable in 2008 recommending the then-99-year-old for treatment when consulted about Gurney's case by a surgeon at Cape Cod Hospital.

    "We're seeing more and more people who are diagnosed with cancer in their 80s, 90s, or, in Bill's case, beyond," says Fuchs.

    "Part of this reflects that people are living longer and better. In some cases, you might find other health problems that would make one hesitate to pursue surgery or further treatment, but we felt a robust gentleman like Mr. Gurney should have both."

    Since surgery to remove his tumor, Gurney has been coming to Dana-Farber every three months for blood work and a physical exam (along with occasional CAT scans), and to meet with Fuchs.

    The two decided Gurney would do best on a "watch-and-wait" approach rather than chemotherapy, and so far the cancer has not returned.

    Gurney still doesn't worry, except about the continued good health of his companion, Mary Kay Lowe, an equally fit "younger woman" in her 80s who accompanies him to all his appointments.

    Not all cases involving elderly cancer patients are so clearly defined. Often it is difficult to determine whether someone over age 70 can handle the side-effects of surgery or chemotherapy.

    One study of more than 12,700 colon cancer patients - about 2,000 of them over age 70 - found that aggressive combination chemotherapy was far less effective in the older patients.

    In some cases, they could not tolerate more potent drugs and left a treatment regimen before its completion. In other cases, physicians may have felt patients couldn't handle treatment or surgery, and recommended less aggressive therapy.

    Building on these findings, an international team including Fuchs' Dana-Farber colleagues Nadine Jackson McCleary, MD, MPH, and Jeffrey Meyerhardt, MD, MPH, are forming a large clinical trial of older colorectal cancer patients to establish better methods for assessing their condition.

    "More than half of the colorectal patients treated are age 70 or older, but only one-third of them are getting the indicated approved treatment for their stage of disease," says Jackson McCleary.

    "Because so few older patients have previously been on clinical trials, we're using information gained from younger patients to make decisions about the 75-year-olds who walk into our office.

    "We need better ways of determining if they are fit for treatment or vulnerable, and clear steps for how to adjust treatment, when necessary, to something that is tolerable yet still effective."

    For patients of any age, McCleary and Fuchs stress, proper preventive measures are essential to catching colorectal cancer early.

    "If you are at average risk for colon cancer, you should start getting colonoscopies every 10 years, starting at age 50," Fuchs says.

    "But if you have an immediate family history, we want you to start at age 35 or 40 and get screened more often."

    He adds that anyone who has had multiple relatives develop colon cancer should take the further step of getting genetic counseling.

    It's never too late to start being sensible; just ask Bill Gurney, who went nearly 80 years between hospital visits before his diagnosis.

    Now he's become a "regular" at Dana-Farber, and when one of his check-ups fell last year on June 27 - his 101st birthday - the nurses and infusion room staff surprised him with a cake and sparkling cider.

    Gurney is not sure if cake will be on the agenda for his next appointment this June, but he certainly plans to be there.

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