Chapter 17: Cancer in Older Adults: Nursing Care

Cancer in Older Adults: Nursing Care explores biological theories such as the cellular clock and genome error theories to explain why senescent cells become increasingly prone to DNA aberrations and less capable of genetic repair. The development of malignancy is detailed through three critical stages: initiation, which involves irreversible genetic mutation; promotion, a reversible phase influenced by prolonged exposure to environmental carcinogens; and progression, leading to metastasis. The text underscores the importance of the human genome and specialized markers like BRCA1, BRCA2, and HER2 in advancing early detection and targeted pharmacological treatments. Furthermore, the chapter highlights significant racial and ethnic disparities in cancer incidence and survival, pointing to socioeconomic status and lack of healthcare access as primary drivers of these inequities. In-depth analysis is provided for common malignancies including lung, breast, prostate, and colorectal cancers, alongside a critical evaluation of screening methodologies. It cautions against diagnostic biases—such as lead-time, length, and overdetection—which can complicate screening decisions for older adults with limited life expectancies. To address these complexities, the use of a Comprehensive Geriatric Assessment (CGA) is advocated to individualize care plans, balancing aggressive interventions like systemic chemotherapy and radiation with the patient’s functional status and quality of life. Management of common treatment toxicities, such as myelosuppression, oral mucositis, and nutritional depletion, is identified as a priority for nursing care. Finally, the chapter addresses the psychosocial impact of a cancer diagnosis, focusing on depression, social isolation, and the unique experience of navigating a terminal illness in the context of a life mostly lived, while offering extensive resources for palliative and hospice support.