Chapter 17: Cancer in Older Adults: Nursing Care

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I want to start today with a number that actually stopped me in my tracks when I was reading through our stack for this deep dive.

It's a statistic that completely changes how you look at the patients in any hospital waiting room.

Sixty percent.

Sixty percent.

Yeah, it's a number that really defines the whole scope of the problem we're tackling today.

Sixty percent of all new cancer diagnoses happen in adults over the age of 65.

And if you think that's high, the next number is even heavier,

seventy percent.

Seventy percent of all cancer deaths occur in that exact same age group.

It really frames the conversation immediately, doesn't it?

We often think of cancer as this, you know, universal enemy.

And it is, but statistically,

it is overwhelmingly a disease of aging.

Overwhelmingly.

If you're going into nursing or even if you're just trying to understand modern health care.

You cannot separate oncology from gerontology.

They are.

They're just inextricably linked.

You can't be good at one without understanding the other.

Exactly.

And that is our mission today.

We are doing a deep dive into Chapter 17, which is titled Simply Cancer from the textbook Gerontologic Nursing.

It's the fifth edition by Suey Minor.

And we are really trying to strip away the density of the medical text and build a clear clinical roadmap specifically for you if you're a nursing student or really anyone who wants to understand the unique challenges of treating older adults.

And it is unique.

I mean, treating a 30 year old with cancer is fundamentally different from treating an 80 year old.

The physiology is different.

The psychological context is different.

And the ethical questions, which we'll definitely get into, are so much more complex.

The textbook makes it really clear that we aren't just applying standard protocols here.

We are navigating a very, very specific biological landscape.

So here's our roadmap for this deep dive.

We're going to start with the epidemiology, you know, who is getting sick and why.

We'll look at the biological theories of why aging itself kind of triggers cancer.

Then we're going to break down the big four malignancies that you will see most often in your practice.

And then we have to wade into the murky waters of screening ethics.

This is where we get into concepts like lead time bias and the five year rule.

It's fascinating and kind of counterintuitive stuff that challenges a lot of standard medical dogma.

Absolutely.

And finally, we will wrap up with the nursing care itself managing side effects, the specific psychosocial needs of older adults, and how to handle the heavy emotional weight of a diagnosis at the end of life.

A huge part of the job.

So let's unpack this.

We've mentioned the silver tsunami in previous deep dives, but how does that specifically apply to oncology?

Well demographic shifts are everything in health care planning.

I mean, by the year 2040, the population of adults over 85, the oldest sold, is expected to hit 14 million.

14 million, wow.

And as the population ages, cancer prevalence just rises naturally.

It's a numbers game.

The text mentions that by 2050, the number of new cancer diagnoses is expected to jump by 42%.

42%.

Yeah.

And that isn't just a statistic.

That represents a massive operational challenge for every single hospital and clinic in the country.

That is a massive surge on the system.

But when I was looking at tables 17 to 1 and 17 to 2 in the chapter, it became clear this isn't evenly distributed at all.

The racial and ethnic disparities are, well, they're stark.

They are.

And this is so crucial for clinical awareness.

You can't just treat everyone as a generic patient.

The text highlights that African Americans face the highest overall incidence and mortality rates.

The highest.

Specifically,

African American men have a 33 % higher death rate than Caucasian men.

A third higher.

That's a staggering gap.

It is.

It's a gap a nurse needs to be aware of from the moment a patient walks in the door.

It signals a need for potentially more aggressive monitoring or, you know, earlier conversations about risk.

And then when we look at the Asian Pacific Islander group, the text makes a really, really important point about not treating this group as a monolith.

Yes.

I feel like often in medical stats, Asian gets grouped into one big bucket and that just masks the real risks.

Right.

And that's clinically dangerous.

So generally, Asian Pacific Islanders have lower overall cancer rates compared to other groups.

But if you look closer, like the text breaks down, there are these specific spights.

Like what?

For example, Korean men have much higher rates of stomach cancer.

Vietnamese men have higher rates of liver cancer.

And here's a big one.

Vietnamese women have a rate of cervical cancer that is more than two and a half times higher than any other group.

Two and a half times.

That's a huge clinical red flag if you're taking a patient history.

Absolutely.

I mean, if you have a Vietnamese female patient,

that cervical cancer screen becomes a much higher priority than it might be for a different demographic.

It has to be.

And we see similar specific trends in Native American populations.

For instance, Southwest Indians have high rates of gallbladder cancer, while Alaska Natives have a higher incidence of kidney cancer.

I see.

Understanding these subpopulations helps you look for the right things.

It moves you from just being a generalist to someone who is actually looking for the specific risks for the patient right there in front of you.

Now, the text makes a very strong assertion here.

It lists all these racial differences, but then it pivots to what might be the real driver.

It suggests we might be looking at the wrong variable if we only look at race.

This is the cause behind the cause.

I love that idea.

While race helps us identify patterns,

socioeconomic status is often the major determinant of both risk and outcome.

So poverty.

Right.

Poverty correlates with a lack of prevention, with poor nutrition, environmental exposure, and delayed access to care.

The text cites Freeman's investigation, noting that if you correct for poverty, so if you compare rich people of different races versus poor people of different races, a lot of those racial disparities, they shrink or even disappear.

So it's about access and environment as much as it is about genetics.

Exactly.

It's about who can afford the healthy food, who lives away from the factory smoke, and who has the insurance to see a doctor when that first symptom appears.

The text really implies that addressing poverty is, in many ways, a form of cancer prevention.

Which transitions us perfectly into the biology.

Why does age itself increase risk?

I mean, even if you're wealthy and healthy, just getting older makes you more likely to get cancer.

The chapter talks about a couple of theories.

One is the cellular clock theory.

Right.

This is the idea that we are essentially programmed to stop.

Humans have a biologically programmed lifespan of roughly a hundred years.

Our cells have a limited number of times they can replicate.

After a certain number of divisions, they enter a state called senescence.

They stop dividing, but they don't die.

They just sort of sit there.

They become zombie cells?

In a way, yeah.

They're functioning, but they're vulnerable.

And vulnerable is the key word here.

Aging cells are more prone to damage, and crucially, they are less able to repair their own DNA.

So you have a genome error theory working in parallel with that.

Environmental factors pile up damage over time, and the aging repair crew in our cells just can't keep up.

The longer you live, the more errors accumulate in your genetic code.

The text breaks down cancer growth into three stages, which I found really helpful for visualizing the whole process.

It's initiation, promotion, and progression, and it visualizes this in figure 17 to 1.

Can we walk through those?

Sure.

And this distinction is vital for understanding prevention.

Stage one is initiation.

This is where exposure to a carcinogen -like radiation, a chemical, a virus,

causes a mutation in the DNA.

The text emphasizes that this is often irreversible.

So once the switch is flipped, it's flipped.

Pretty much.

The DNA is altered.

OK, so the damage is done, but that doesn't automatically mean a tumor, right?

If I get a sunburn, I don't immediately have melanoma.

Correct.

And that brings us to stage two.

Promotion.

Now, this is the most important phase for nurses and health educators to really get.

Promoters are substances that stimulate that initiated damaged cell to start replicating.

Like what?

What are promoters?

These are things like tobacco, high -fat diets, or alcohol.

They essentially water the seeds of those damaged cells.

And the text says this phase is reversible.

Yes.

That's the aha moment of the chapter, I think.

Promotion is reversible.

If you remove the promoter, if you stop smoking, if you improve the diet, you can halt the process.

Wow.

The damaged cell doesn't necessarily become a tumor, it can just sit there, initiated but dormant.

That is such a powerful message for patients.

It's never too late to stop a promoter.

I think so many older adults think, well, I've smoked for 40 years, the damage is done, why should I quit now?

Exactly.

And the science says, quit now.

Even an older age, removing that promoter alters the course.

But if you don't, you hit stage three.

Which is progression.

Right.

That's when it transforms into a tumor, starts aggressive clonal growth, and eventually metastasizes.

That's the wildfire.

Once progression starts, lifestyle changes alone won't stop it.

You need medical intervention.

And we also have to mention the immune system's role here.

The book talks about immunosessence.

It's exactly what it sounds like.

The aging immune system, it gets tired.

It has a decreased ability to surveil the body and destroy abnormal cells.

In a young person, the immune system might spot that mutated cell and just kill it immediately.

In an older adult, the security guard is kind of asleep at the gate.

So you have more damaged cells, you have more promoters acting on them, and you have a weaker defense.

It's the perfect storm for a malignancy.

Okay, let's move to the clinical roadmap.

The text refers to the big four common malignancies in older adults.

Number one, unsurprisingly but tragically, is lung cancer.

Yeah, the leading cause of cancer death.

And there is a gender split happening here that's quite interesting.

Rates are actually dropping for men, largely due to historical smoking cessation trends.

But not for women.

But they're still rising for women.

The text suggests this correlates with the timeline of when women began smoking in larger numbers decades ago.

We're seeing that lag time play out now.

And for the nursing students listening, what does this look like clinically?

Because the text warns that it's often asymptomatic until it's very late.

That's the danger.

By the time you see the classic signs of persistent cough, blood streaks, sputum, chest pain, it's often advanced.

And in older adults, these symptoms get dismissed.

All the time.

The patient thinks, oh, it's just my chronic bronchitis, or it's just a lingering cold.

Or the classic, I'm just getting old.

Nurses need to have a very high index of suspicion.

If that cough isn't going away, investigate it.

Don't let age be an excuse for ignoring symptoms.

The chapter also differentiates between two main types, small cell and non -small cell.

What's the quick breakdown there?

So small cell lung cancer, or SCLC, is the aggressive one.

You can think small but speedy.

It metastasizes early and it metastasizes widely.

It's very strongly linked to smoking.

And the prognosis is not great.

Generally poor, because it moves so fast.

Often it is spread to the brain or bones before it's even found in the lung.

And non -small cell.

Non -small cell, or NS -CLC, is much more common, about 80 % of cases.

It grows slower.

This includes adenocarcinomas and squamous cell carcinomas.

Because it's slower, you have more treatment options if you catch it.

But catching it is the hard part.

That's the challenge.

OK, moving to number two on the list, breast cancer.

The statistics here are just crystal clear.

79 % of new breast cancer cases are in women over 50.

It is a disease of aging.

And we have to talk about the genetics, BRCA1 and BRCA2.

Right.

These are tumor suppressor genes.

We all have them.

Their job is to repair our DNA.

Yeah.

But if you inherit a mutation in BRCA1 or BRCA2,

your risk just skyrockets because that repair mechanism is broken.

I see.

The text notes that while these are often associated with younger onset, they are still really relevant factors in the older population's family history.

Let's talk clinical assessment.

The text describes the difference between a benign lump and a malignant one.

And it uses this frozen pea analogy.

This is a great tactile analogy for students.

When you are palpating a breast, benign lumps like cysts or fibroadenomas, they usually feel soft, mobile, and have smooth borders.

You can sort of wiggle them around under the skin.

A malignant tumor, on the other hand, often feels like a frozen pea.

Hard, fixed in place, and irregular.

It doesn't want to move.

It feels anchored to the tissue.

And you should also be looking for the orange peel skin.

Poderange, yep.

That indicates edema, which is caused by the tumor -blocking lymph drainage.

The skin looks dimpled, literally like the skin of an orange.

It's a late sign, but it's a critical one.

If you see that, the cancer is likely advanced.

Here's where it gets really interesting for me.

The text says mammography is actually more accurate in older women than in younger women.

I would have thought it was the same, or maybe even harder because of aging tissue.

It's actually the opposite.

It all comes down to density.

Younger women tend to have dense glandular breast tissue, which shows up white on a mammogram.

Tumors also show up white, so it's like trying to find a snowball in a blizzard.

As women age, that breast tissue becomes less dense and more fatty.

Fat shows up darker on the scan.

So the contrast makes the white tumor stand out much more clearly against that dark background.

That is a fascinating detail.

So the test actually gets better with age.

Okay, number three, prostate cancer.

One in six men.

It is almost inevitable if a man lives long enough, but the text notes that most men who are diagnosed with prostate cancer will not die from it.

They die with it.

They die with it.

Exactly.

It's often very, very slow growing.

The symptoms can be tricky because they mimic benign prostatic hyperplasia, BPH, which is super common in older men.

Exactly.

A weak stream, urinary frequency, waking up at night to go.

It looks just like BPH.

And that's why the screening debate is so heated.

With the PSA and the DRE.

Right, the PSA prostate specific antigen test and the digital rectal exam.

But the text points out that widespread screening hasn't necessarily lowered death rates significantly because we are catching so many of these slow growing cancers that would never have killed the patient anyway.

Which ties directly into the ethics we'll get to in a minute.

But first, the fourth one, colorectal cancer.

Third most common cancer.

And here, location really matters for the nurse doing the assessment.

The symptoms depend entirely on where the tumor is, right side or left side of the colon.

Right, the text splits it into right colon versus left colon.

Let's start with the right.

So think about the anatomy.

The ascending colon on the right side is wider.

The stool there is still liquid, coming from the small intestine.

Tumors here can grow quite large without blocking the bowel because the liquid stool just flows around them.

So the symptoms are vague.

Very vague.

Cramping, maybe a dull pain that feels like appendicitis and anemia from hidden blood loss.

You won't necessarily see blood in the toilet because it's all mixed in higher up.

Then the left side.

The descending colon on the left is narrower and the stool is solidifying.

Tumors here tend to encircle the bowel, kind of like a napkin ring.

They cause constriction.

So you see pencil stools, very thin stool trying to squeeze past the tumor.

And because it's closer to the exit, you see bright red bleeding.

So they get caught earlier.

Ironically, yes.

Left -sided cancers are often caught earlier because that bright red blood alarms the patient more than a dull ache does.

And obviously, colonoscopy is the gold standard for screening here.

Yes.

It allows for the removal of polyps before they even become cancer.

It's prevention and detection all in one.

The text mentions fecal occult blood testing too, but colonoscopy is the definitive tool.

So we've established the diseases.

Now we get to the part of the chapter that I think requires the most critical thinking.

Screening, ethics, and biases.

The text makes a really bold statement.

It advises against screening if life expectancy is less than five years.

And this is where medicine meets philosophy, really.

The whole goal of screening is to find a disease early enough to treat it and extend life.

If a patient has severe heart failure and is unlikely to live five years, finding a slow -growing prostate cancer does not help them.

It only burdens them with biopsies, surgeries, and anxiety in their final years.

It violates the principle of non -maleficence.

First, do no harm.

But figuring out that five -year window is hard.

And understanding the data is even harder because of these biases.

The text lists three.

Lead time bias, length bias, and overdetection bias.

We need to unpack these.

Let's start with lead time bias.

This one.

It tricks our brain the most.

Imagine two men, Bob and John.

They both have the exact same aggressive cancer that is destined to kill them at age 70.

John doesn't get screened.

He gets symptoms at 69, is diagnosed, and dies at 70.

So he lived with a cancer diagnosis for one year.

Okay.

And Bob?

Bob gets screened at 65.

The test finds the cancer.

But because the cancer is aggressive and untreatable, he still dies at 70.

But on paper, it looks like Bob lived with cancer for five years.

I see.

It looks like screening added four years to his life.

It didn't.

It just added four years of knowing he had cancer.

That's lead time bias.

It inflates survival statistics without actually changing the outcome.

That is kind of depressing, but it makes total sense.

You're just moving the diagnosis date back, not the death date forward.

What about length bias?

Length bias is all about the speed of the tumor.

Imagine you are fishing with a net.

The fast fish, they swim right through the net before you can pull it up.

The slow fish get caught.

Screening is a net.

Screening is a net.

Fast -growing, aggressive tumors move so quickly from undetectable to symptomatic, they just pop up between screenings.

But slow -growing tumors, they sit there for a long time, so screening tests are much, much more likely to catch them.

So the people who are saved by screening are often the ones who had the better, slower cancer to begin with.

Exactly.

It makes the screening look more effective than it really is because the sample is skewed toward the survivors.

We catch the turtles, but the rabbits still get away.

And the third one, over -detection bias.

I think we touched on this with prostate cancer.

Yes, this is a huge one.

This is finding a cancer that would never have become clinically significant in the first place.

If you autopsy men over 80 who died of heart attacks,

a huge percentage have prostate cancer.

And they never knew.

They didn't know.

It didn't hurt them.

If you had screened them and found it, you might have subjected them to radiation and surgery they didn't need.

That is over -detection.

It's finding a disease that doesn't need to be found.

So the nursing role here shifts from just, you know, following robotic guidelines to something much more nuanced.

It moves to individualized assessment.

You have to look at the whole person, their poor morbidities.

If a patient has advanced Alzheimer's and congestive heart failure, does a mammogram serve their quality of life?

Probably not.

Right.

It's about protecting the patient from the medical system as much as it is protecting them from the disease.

Which brings us to treatment.

If we do decide to treat, how does the older body handle it?

Let's talk surgery.

Is age a contraindication for surgery?

The text is really emphatic on this.

Age itself is not a contraindication.

An 80 -year -old can absolutely tolerate surgery.

The risk lies in their decreased reserve.

Decreased reserve?

Explain that.

Think of it like a savings account for stress.

A younger person has a huge savings account of cardiac, renal, and respiratory function.

If surgery costs a lot of stress, they can pay for it.

They have the funds.

They have the funds.

An older adult often has just enough function for daily life.

Surgery demands extra.

If they don't have that reserve, they can tip over into failure, heart failure, kidney failure, respiratory failure.

So the pre -op assessment isn't about age.

It's about checking the balance in that account.

Okay, what about chemotherapy?

I imagine the toxicity is the big issue there.

It is, and the text specifically highlights renal function.

This is the single biggest physiological factor you have to watch.

Many chemo drugs, like methotrexate or cisplatin, are excreted by the kidneys.

And aging kidneys just don't filter as well.

Correct.

The glomerular filtration rate, the GFR, it drops with age.

If you give a standard dose to an older adult, but their kidneys only clear half of it, the drug stays in the blood longer.

It reaches toxic levels.

You're essentially overdosing them, even if you followed the label.

So start low and go slow definitely applies here.

Absolutely.

Plus, their body composition changes.

Older adults have less total body water and more fat.

So water -soluble drugs become more concentrated because there's less water to dilute them in.

And fat -soluble drugs.

They hang around longer because there's more fat to store them in.

It changes the pharmacokinetics entirely.

We also have biologic therapy mentioned using the immune system to fight cancer.

Yes, things like interferons and monoclonal antibodies.

It sounds gentler than chemo because it's biological, but the text warns they still have significant side effects.

Like what?

Things like fever, chills, and major fatigue, which can be incredibly taxing on a frail older adult.

It's definitely not a free pass.

Let's get into the weeds of nursing care.

This is the what do I do on my shift section.

The chapter focuses heavily on managing side effects and the big one is myelosuppression.

Right.

Bone marrow suppression.

This is the most common toxicity and it hits three lines, white blood cells, platelets, and red blood cells.

Okay, let's break those down.

First, neutropenia, low white count.

So infection risk.

This is life or death.

The clinical pearl here for nurses is about temperature monitoring.

The text specifically mentions that older adults with vision issues might struggle to read those old glass thermometers.

So use a digital one.

Yes.

But more importantly, you have to realize that a temperature of just 100 degrees ferrous or 37 .8 degrees C is a major red flag.

Older adults often run cooler baseline temps and they don't mount fevers as robustly as young people do.

So a low grade fever is actually a high grade emergency.

It's a screaming siren.

100 degrees in an 80 year old chemo patient might be the only sign of sepsis you get.

You cannot wait for 101 or 102.

Got it.

Then there is thrombocytopenia, low platelets,

bleeding risk.

The advice here is all practical.

No straight razors, electric only, soft toothbrushes to prevent gum bleeding, and a big one the text points out, no suppositories.

Why no suppositories?

That seems like a really standard route for meds and older adults.

Not if they have low platelets.

The rectal mucosa is very fragile and highly vascular.

Inserting a suppository can cause trauma, which leads to bleeding.

Plus if they're also neutropenic, so low white cells, you're risking introducing bacteria from the bowel directly into the bloodstream through that microtrauma.

It's a double risk.

It's a huge do not do in oncology nursing.

That is a crucial specific detail.

Okay.

And then GI toxicity,

nausea and vomiting.

In an older adult, vomiting isn't just uncomfortable, it's dangerous.

They dehydrate so much faster than younger adults.

And dehydration leads to electrolyte imbalances, which can cause confusion or delirium.

So suddenly you have a fall risk.

Exactly.

Or a major cognitive change just from nausea.

Anti -emetics need to be given aggressively and proactively, not just when they feel sick.

The text also mentions mucositis inflammation of the mouth.

Which is incredibly painful sores in the mouth.

The tip here is to avoid alcohol -based mouthwashes.

They sting and they dry out the tissue.

And the nurse has to assess for chewing and swallowing difficulties.

Because if their mouth hurts, they stop eating.

They stop eating.

And if they stop eating, they lose weight and protein, and their ability to heal from the chemo just plummets.

It's a vicious cycle anorexia leading to cachexia.

You have to keep them eating, even if it's just soft, bland, high calorie foods.

And one side effect that often gets minimized, but the text highlights, is alopecia hair loss.

It's never just hair.

For an older adult who may already be dealing with so many other losses of independence,

of their role losing their hair,

is an assault on their identity.

Absolutely.

The text gives a great piece of advice,

suggest getting a wig before the hair falls out.

Right, so you can match the style and color while it's still there.

Exactly.

Once it's gone, it's hard to remember exactly what it looked like or to even feel comfortable shopping.

It's all about preserving dignity.

It helps them recognize themselves in the mirror during a really tough time.

Let's transition to the final section, the psychosocial dimension.

The text uses a phrase I really loved,

cancer in the context of a life mostly lived.

It's a beautiful and necessary distinction, isn't it?

For a 25 -year -old, cancer is a life interrupted.

It's a tragedy of potential unfulfilled.

For an 80 -year -old, the context is completely different.

How so?

They have lived.

They have history.

The grief is different.

It's not necessarily less painful, but it is different.

It's often focused on leaving things in order, on legacy, and on maintaining autonomy for the time they have left.

We talk a lot about quality of life, or QOL.

How is that defined for this population?

It's multi -dimensional, so physical, psychological, social, spiritual.

But studies show that for older adults, vitality and independence are often the top priorities.

They might care less about living an extra six months and more about being able to walk to the bathroom by themselves or stay in their own home.

As nurses, we need to ask, what is most important to you right now?

And then actually listen to the answer, even if it contradicts our medical instinct to just fix everything.

The chapter also draws a really important line between depression and grief.

This is a critical differential diagnosis.

Grief is a natural reaction to loss, loss of health, loss of a breath, loss of the future you thought you had.

It comes in waves, but the person still has moments of connection and even joy.

And depression.

Depression is persistent.

It's a flat line of despair.

The text emphasizes this.

Depression is not a normal part of aging, and it is not a normal part of having cancer.

It must be treated.

Do not assume grandpa is just sad because he has cancer.

He might be clinically depressed and need real help.

And social isolation is another big issue.

It can be voluntary, you know, withdrawing to reflect, which can be OK.

Or it can be involuntary.

Their friends have died.

They can't drive anymore.

They're afraid of incontinence if they go out in public.

The nurse needs to investigate why they're alone.

If it's involuntary, we need to intervene with social work or community resources.

Finally, the text reframes denial.

We often see denial as a bad thing, like, oh, he's in denial.

He won't accept the diagnosis.

The text calls it titration.

I love this medical metaphor.

Just as we titrate a drug to let the body handle it, given a little bit at a time, the mind titrates bad news.

So denial is a coping mechanism.

It's a coping mechanism that lets the patient absorb the shock in small, tolerable doses.

They might acknowledge the tumor today, but ignore the prognosis until next week, and that's OK.

So as a nurse, you don't smash through the denial.

No.

You respect their pace.

You don't lie.

But you also don't force them to confront the entire reality before they are ready.

You let them sip the information rather than drowning them in it.

It allows them to maintain psychological stability while they process the trauma.

That is such a humane approach to care.

It is.

It's patient -centered care in its purest form.

So we've covered the stats, the biology, the big four, the ethics of screening, the treatment, and the care.

If we had to summarize the core message for everyone listening...

I'd say the core message is balance.

Treating the older adult with cancer requires balancing aggressive medical intervention with a deep, profound respect for their functional status, their remaining time, and their personal values.

It's not just, can we treat this?

It's, should we treat this, and does it serve the patient's goals?

That's the real question.

And as we close out, I want to leave you with a thought that really struck me regarding that concept of over -detection we discussed.

As our technology improves, as our scanners get better and our blood tests get more sensitive, we are going to find more and more cancer in older adults.

We are.

We will find every tiny abnormality.

The challenge for the future nurse, for you listening, is going to be protecting your patient's time.

How do we ensure that their final years aren't consumed by the medicalization of a condition that might never have harmed them?

It's a question of stewardship.

Are we stewards of their health, or are we just technicians of their disease?

That is the ultimate question in gerontologic oncology, I think.

Something to mull over.

Thank you so much for joining us on this deep dive into Chapter 17.

We hope this roadmap helps you navigate the complexities of cancer in the older adult.

Thanks for listening.

This has been the Last Minute Lecture Team, signing off.