Optimizing Cancer Care for Older Adults With Carolina Uranga, DNP, APRN, AGCNS-BC, OCN®, NPD-BC, EBP-C

Why Age Matters in Oncology

“Older adults are estimated to make up about 20% of the US population by 2030,” Dr. Uranga explained, noting that cancer survivorship is projected to increase from 18.1 to 26 million by 2040. “It’s that silver tsunami that people talk about—10,000 baby boomers are turning 65 every day, and that’s been happening since 2011.” This demographic shift means oncology teams will increasingly care for older adults, both newly diagnosed patients and long-term survivors.

Dr. Uranga emphasized, “It’s important that oncology nurses start to integrate geriatric assessment tools into practice so that they are providing optimal care and also improving care of older adults with cancer.”

Life in Three Acts

To illustrate the diversity within the adult population, Ms. Uranga divided the lifespan into three “acts”:

• Act One (Ages 0–29): “This age group has optimal physiological reserve, and they often receive aggressive treatment for their cancer.” Cancer incidence is low (3.7%), and clinical trial participation is high.
• Act Two (Ages 30–59): Incidence rises to nearly 40%. “You start to see some changes to their physiological reserve, and you start to see some chronic diseases such as heart disease, diabetes, hypertension.”
• Act Three (Ages 60–89+): Over 56% of new cancer diagnoses occur here, with a median age of 67. “The physiological reserve for this group is starting to go, there’s a lot of changes going on to various body systems, and homeostatic mechanisms and immunological functions decrease in this age group.”

She highlighted the complexity of care: “Older patients often have more comorbidities like diabetes, hypertension, and heart disease on top of the cancer.”

Frailty, Polypharmacy, and Atypical Presentations

Dr. Uranga described the unique challenges of caring for older adults with cancer:

• Frailty and Functional Decline: “You really start to see changes with frailty or functional decline in those that are 85 and older—increased risk of infection like urinary tract infections (UTIs) and pneumonia.”
• Atypical Presentations: “UTIs or pneumonia in someone younger may manifest as high temperatures or pain. For UTI in older adults, it may just manifest as confusion. They may become delirious.”
• Polypharmacy: “Older adults are prone to having many medications, sometimes five or more. We call that polypharmacy, and that could lead to adverse drug reactions and contraindications.”
• Functional Status: “Can they dress themselves, feed themselves, can they get out of bed? These activities are crucial for someone.”

She also noted the importance of interpreting lab values and medication effects in the context of age-related changes in organ function.

Geriatric Assessment

A central theme of Dr. Uranga’s presentation was the value of geriatric assessment. “A geriatric assessment is basically a questionnaire, but it’s self-reported. It has various domains such as what are their goals, what social support they have, what is their psychological status, functional status, medications, cognition, nutrition, and comorbidities.”

She explained, “Each domain provides a little snapshot of their concerns or issues specific to that, and all of these can impact the care trajectory and outcomes for their treatment.” The assessment helps clinicians proactively address vulnerabilities, such as referring to occupational therapy for fatigue or arranging transportation for those with poor social support.

Dr. Uranga highlighted the Geriatric 8 (G8) screening tool: “It’s eight questions. If they get less than a score of 12, then that would be an indication that they need more comprehensive geriatric assessment.” She also recommended the Mini-Cog for cognitive screening and the sit-to-stand test for fall risk, noting, “You could refer them to physical therapy or ask the pharmacy to do a medication review.”

Centering the Patient

Ms. Uranga urged clinicians to focus on patient goals: “What are the goals they have for their treatment? Because if the treatment effects are not within what they consider their best quality of life, that’s important to them. You want to take that into consideration as you provide treatment.”

Key Takeaways

• The aging population will dramatically increase the number of older adults with cancer, requiring specialized approaches.
• Older adults often present with frailty, comorbidities, polypharmacy, and atypical symptoms, demanding comprehensive assessment.
• Tools like the G8, Mini-Cog, and the sit-to-stand test help identify vulnerabilities and guide interventions.
• Treatment plans should align with the patient’s goals and quality of life priorities.
• Oncology nurses, physicians, and pharmacists must work together to address the multifaceted needs of older adults with cancer.

Resources

Home | American Geriatrics Society

ACCC | Association of Cancer Care Centers

Age-Friendly Health Systems Resources and News | Institute for Healthcare Improvement

Cancer and Aging Research Group – Improving the care of older adults with cancer

Caring for Older Adults with Cancer: A Toolkit for Oncology Nurses – CANO/ACIO

Gerontological Society of America – GSA

National Institute on Aging

New Geriatric Assessment Guide Gives Cancer Care Teams Tools to Help Aging Patients

Older Adult Oncology – Guidelines Detail

Global Search | Oncology Nursing Society

Princess Margaret Cancer Campus

SIOG – International Society of Geriatric Oncology

Silver Sneakers – 6 Best Balance Exercises for Seniors

STEADI – Older Adult Fall Prevention | STEADI – Older Adult Fall Prevention | CDC

The National Council on Aging (NCOA)

How to Do a Geriatric Assessment

What to Do With the Results of a Geriatric Assessment

About Dr. Uranga

Carolina Uranga, DNP, APRN, AGCNS-BC, OCN®, NPD-BC, EBP-C, is an Adult Gerontology Clinical Nurse Specialist and Quality Improvement Specialist at City of Hope. She has an extensive experience in oncology nursing with over 25 years of expertise, and she is passionate about advancing the care of older adults with cancer through education, assessment, and patient-centered practice.