Older Adults Older adults are defined as those age 65 and over, representing 64 percent of cancer survivors in the United States. This population is also the fastest growing and is projected to increase to 73 percent of cancer survivors by 2040 (609). Cachexia is common among older cancer survivors, especially among those with gastrointestinal cancers; an estimated 52 to 65 percent of older cancer survivors develop cachexia (610,611). Specifically, loss of muscle mass and strength, called sarcopenia, occurs in 12.5 to 57.7 percent of adult cancer survivors (612-615). Fracture risk due to bone density loss (osteoporosis) is becoming another increasing concern in this demographic. In one study of older adults with a mean age of 69 years, researchers found that cancer survivors diagnosed within the last five years had two times the risk of bone fracture compared to those with no history of cancer. It is important to note that higher fracture risk was positively associated with current smoking status (616). Older adults may benefit from programs, such as physical therapy and smoking cessation, that are shown to reduce the risk of fracture (617). Research into older cancer survivors and their unique risks is important as the U.S. population ages, life expectancy increases, and cancer survivorship rises. Improving Health-related Quality of Life and Outcomes Promoting Healthy Behaviors Healthy behaviors, such as physical activity, a healthy diet, reduced alcohol consumption, and smoking cessation, can significantly improve both health outcomes and health-related quality of life (HRQOL) for cancer survivors. In fact, it is increasingly appreciated that adopting healthy behaviors after a diagnosis of cancer but prior to beginning cancer treatment, called prehabilitation or “prehab” can significantly improve outcomes for patients. A patient who is healthy at the start of treatment can undergo higher doses of drug, is less susceptible to certain side effects, and has an immune system that is primed to fight cancer better. Physical activity has been shown to increase survival and lower recurrence of cancers (618). Physical activity changes how organs and tissues function to resist both cancer progression and/or metastasis. Because the body requires energy (in the form of carbohydrates, such as glucose), increasing physical activity levels increases the demand for energy from organs. One study found that by increasing physical activity levels, the amount of energy that was available to tumors was reduced because it was needed by the rest of the body during physical activity. Participants who were more active had lower rates of metastatic progression compared to those who were not active (175). Physical activity can also improve treatment outcomes. A metaanalysis of breast cancer survivors who underwent curative treatment found that frequent physical activity improved HRQOL, cardiorespiratory fitness, and body composition (619). A second study showed that in a group of patients who underwent radiotherapy for breast cancer, biweekly aerobic exercise sessions of 30 to 40 minutes each significantly improved cancer-related fatigue and HRQOL (620). Research has shown that sustaining a healthy diet that consists of whole grains, fruits, and vegetables can increase survival from cancer and reduce the risk of cancer recurrence (622). Cancer survivors who adhere to a high-quality, balanced diet have better quality of life, mental well-being, and survival (623-626). Diet is also important for maintaining a healthy gut microbiome, which is the collection of organisms that occupy the intestines and aid in digestion (see Targeting the Microbiome in Cancer Treatment, p. 150). Smoking among cancer survivors is associated with poor outcomes and greater treatment-related complications, higher risk of secondary cancers, and greater mortality (123). Smoking cessation is a crucial intervention that can improve clinical outcomes during and after the completion of cancer treatment (627). Many cancer-focused professional organizations strongly recommend smoking cessation after a cancer diagnosis. Evidence demonstrates that the most successful methods include involving a trained tobacco specialist who can screen patients and assist them in achieving abstinence; improving clinician education on how to deal with and refer patients appropriately; and building relationships with implementation stakeholders (628). Integrating Palliative Care Palliative care is an approach to prevent or treat the symptoms and side effects of any disease, including cancer, by addressing the physical, psychosocial, financial, and spiritual needs that arise from the disease and treatments (see Sidebar 44, p. 139). Palliative care is facilitated by multidisciplinary teams of doctors, nurses, dieticians, pharmacists, therapists, spiritual leaders, and social workers and has been shown to improve quality of life for patients, families, and caregivers. In breast cancer survivors, moderate exercise is associated with a 60 percent lower risk of death (621). AACR Cancer Progress Report 2023 Supporting Cancer Patients and Survivors 138
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