The number of adults over the age of 55 is expected to double in the next 30 years1. Because there will be more adults older than 55, there will undoubtedly be more cancer, because the incidence of cancer rises with age2. If you are over the age of 55, you should consider your "AGE" when you are treated for any disease, but especially for cancer. AGE stands for:

• Age— your chronological age, not your biological age;
  
• Goals—your treatment plan and expected outcomes; and
  
• Expectations—of your treatment team and other organizations you rely on for help.

The difference between chronological age and biological age may be striking. Biological age is how old you were at your last birthday. Chronological age is the amount of wear and tear on your body. This includes any chronic conditions you have, your diet, and the amount of exercise you get. This is important because a healthier body is able to tolerate cancer treatments far better than a body with many chronic conditions and little exercise.

When doctors think about a treatment plan, they look at the type of cancer the patient has, the stage of that cancer (its size and spread), whether the cancer is fast- or slow-growing, and the health of the patient. One of the best tools through which older patients can be evaluated is the Comprehensive Geriatric Assessment. This test looks at several criteria:

• independence in daily activities (functional status);
  
• other illnesses;
  
• living conditions and support;
  
• thinking and mood;
  
• medications taken;
  
• nutrition; and
  
• geriatric syndromes such as "sundowner's syndrome" or dementia.

The Comprehensive Geriatric Assessment gives a better picture of a person's ability to tolerate treatment than biological age gives. In addition, it doesn't require special training to administer. Any health care provider can perform this test.

Finally, the information that the assessment reveals is useful for making treatment decisions. This is important because, unfortunately, older people frequently receive reduced-dose treatments for their cancer. These treatments are not as effective as full-dose treatments. In some cases, elders receive no treatment at all, even when it is warranted. During and after treatment, they also tend to receive fewer or no tests to monitor their progress.

Besides biological and chronological age as barriers to treatment, elder persons have historically been under-represented in clinical trials. Therefore, evidence-based guidelines specific to people older than 55 cannot be developed because of lack of data. Health care professionals are reluctant to include elders in clinical trials, and many elders are afraid of clinical trials because they fear getting substandard care or they worry that the cost of the research trial will not be paid by insurance and they will have overwhelming bills.

In truth, age is seldom a restriction for clinical trials. Ask your doctor about clinical trials for which you may be eligible.

Before starting a treatment plan, discuss your expectations with your health care team. Treatment teams consist of some or all of the following people:

• oncologist/hematologist;
  
• radiation oncologist;
  
• primary care physician;
  
• oncology nurse practitioner or physician's assistant;
  
• oncology nurse or treatment nurse;
  
• oncology social worker;
  
• dietitian;
  
• pharmacist;
  
• patient "navigator"; and
  
• insurance case manager.

Here are some questions and concerns to keep in the forefront:

• What are all my treatment options, and why was the recommended plan chosen?
  
• Which team member should we call for concerns, and what is her phone number?
  
• Tell your doctor how you want to receive information; for instance, do you want a call? Can she e-mail or fax information and forms to you? If so, make sure she has your contact numbers.
  
• Who besides you may receive information about your disease?
  
• You should be told when tests will be performed. If possible, ask that they be performed close to your home and before your appointment.
  
• What does the doctor expect from the treatment?
  
• What are the treatment side effects, and how can you prevent or lessen them?
  • Do not be afraid to question your health care team! The team members are working for you, and they have the information you need.
    
  • Before you go to an appointment, think about your questions and write them all down.
    
  • For each appointment, take someone with you. This person can see and hear things that you may miss. He can help communicate with the team and bridge any communication gaps that may develop. He or you can write the answers to your questions. You could even ask your doctor's permission to record the visit and review it at home with your family.
    
  • Finally, reach out to others for support. Your family and friends may be the first people to whom you reach out. You may want to join a support group or talk to other people living with the kind of cancer you have. Your nurse or oncology social worker should be able to help with this.

You are at the center of many people who care for and about you. For the best care, take advantage of everything these caring people have to give.

1 U.S. Census Bureau, "65+ in the United States: 2005," December 2005.

2 American Cancer Society, 2011. "Cancer Facts and Figures," p.1.