Studying best ways to treat older adults with cancer

Cancer is largely a disease of older people, yet few researchers in Canada focus on the treatment of older adults with cancer. Dr. Shabbir Alibhai, a clinical scientist and consultant in geriatric medicine at Toronto Rehab, is one of them.

The focus of Dr. Alibhai's research is optimal treatment of different cancers in older people. He is also looking at the impact of cancer and its treatment on older people's ability to function and their quality of life.

Dr. Alibhai is particularly interested in prostate cancer, acute myeloid leukemia, and musculoskeletal involvement by cancer.

Prostate cancer is usually slow growing. However, treatment can cause many complications including urinary incontinence, lack of energy and loss of sexual and physical function.

"Prostate cancer is the most common cancer in older people, and the second most deadly," says Dr. Alibhai. "Even so, my research shows older people with prostate cancer are systematically undertreated compared to younger ones, even after adjusting for major clinical variables. The healthiest older people are getting treated a lot less than the healthiest younger people with the same kind of prostate cancer.

"Several treatments are probably effective. If we could enhance the access of older people to these therapies we could significantly improve their quality of life and decrease their suffering."

While prostate cancer often progresses over a period of years, most older people with acute leukemia die a few months after diagnosis. Dr. Alibhai is studying whether aggressive chemotherapy can not only extend life but improve its quality in older people. He is also investigating new, less toxic chemotherapies for this disease.

"We're trying to help people live longer and have better quality of life," he says. "We're working to find the best approach for older people with aggressive cancers. We need to know when different techniques should be used - when to give surgery, when to think about chemotherapy, and what all these treatments mean in terms of quality of life. We want to understand the bigger picture.

"With older people, even with aggressive cancers, quality of life can often be improved by aggressive surgery and radiation therapy. That's not commonly done in clinical practice. This needs to be reconsidered."

Dr. Alibhai became interested in cancer in older people while completing his master's in clinical epidemiology. "It's a huge field and a largely unexplored one. The area appealed to me as a researcher.

"I'm interested by the complexity and frailty of patients. Even if I can't help them live a lot longer, I can often make improvements in their quality of life and make them feel more valued as human beings."

Click here to read about Dr. Alibhai's research as featured in the Canadian Cancer Society website