The elderly are a high-risk group for gastric cancer. Most elderly patients have decreased autoimmune and metabolic functions, reduced physiological functions, and often have a combination of multiple diseases, making surgery more risky and requiring some particular attention in treatment and care.
Treatment principles
The principles of treatment for geriatric gastric cancer are basically similar to those of the general adult population. However, due to the special characteristics of the elderly, the incidence of postoperative complications is relatively high. Therefore, in the selection of treatment options, physicians generally pay more attention to the systemic condition of elderly patients, and make individualized choices based on a comprehensive assessment of cardiopulmonary function, the location and degree of progression of the lesion, and economic conditions.
For surgery, physicians will strictly control the indications for surgery and minimize the scope and trauma of surgery while following the principles of tumor treatment. In older patients, the surgeon will also consider radical surgery (i.e., D2 surgery to clear lymph nodes to station 2) for gastric cancer as long as there are no contraindications to surgery. For some advanced gastric cancers, the surgeon may consider palliative resection, and excessive surgical extent and lymph node dissection may only add to the complications and are usually not performed. In elderly patients in particular, adequate preoperative evaluation is needed to rule out contraindications to surgery, and pulmonary function tests are usually performed to initially determine the possibility of respiratory failure, etc., and cardiac function is checked to prevent postoperative heart failure.
Likewise, in treatments such as radiotherapy, older patients in good general condition can usually tolerate standardized radiotherapy, and physicians usually choose a combination chemotherapy regimen. However, physicians also follow the principle of individualization, and some patients who are in better general condition and have well-controlled underlying disease despite their advanced age may be considered for combination intravenous chemotherapy. Monitoring of cardiac function during radiotherapy will also be noted.
Postoperative care
Postoperative family members should assist in observing the condition and informing the healthcare provider of changes in the patient’s condition in a timely manner.
Because elderly patients mostly have chronic lung disease and reduced lung function before surgery, coupled with the effects of surgery and anesthesia on the respiratory tract and postoperative pain that may deter patients from coughing, patients are prone to pulmonary complications. Family members can assist patients to turn and buckle their backs regularly under the guidance of medical staff, and encourage patients to cough and cough up sputum. The family can learn from the medical staff to observe whether the drainage tube is patent, for example, by squeezing the drainage tube to determine the sense of resistance and the fluctuating condition of the fluid level, and also monitor the drainage fluid in real time, record the amount, color, and properties of the drainage fluid, and inform the medical staff promptly if abnormalities are found.
Older patients tend to have hypoproteinemia, diabetes, or obesity, all of which can affect the healing of the incision. Family members can help the patient protect the surgical incision, for example, by pressing their hands on either side of the surgical incision when the patient coughs.
Postoperative diet
Because older patients have lower resistance and are often in poorer health, they need a proper diet to strengthen their bodies.
A diet high in calories, protein, and vitamins is recommended. If a patient has a significant gastrointestinal reaction and decreased appetite during chemotherapy, he or she can skip lunch and have breakfast 1 to 2 hours before chemotherapy and dinner 2 to 4 hours after chemotherapy, which can avoid adverse reactions from eating.
The structure of the diet should also be rational, and the elderly should eat foods that are easy to chew because of reduced digestive function. It is also important to eat small, frequent meals, not too hot or too much food, not too full, and more vegetables and fruits. Caregivers usually advise patients to drink more water to promote chemotherapy drug metabolism and reduce adverse drug reactions. The temperature of the food consumed by the patient should be close to the body temperature, and some cold, hard and spicy foods are forbidden, and some exercise is done after eating to promote peristaltic digestion.
Psychological support
Psychological support
Families also need to pay attention to the psychological support of elderly patients. Patients have different psychological reactions such as fear, doubt, apprehension, and despair due to their respective cultural backgrounds, psychological characteristics, conditions, and perceptions of the disease. Elderly patients often have the idea that they do not want to suffer, do not want to involve their family members, are afraid of trouble, and are worried that they will be left with no money, and they may be sad and depressed, silent, sobbing, not listening to advice, not following medical advice, or even suicidal. The family should be guided according to the patient’s psychological reaction, implement support, eliminate negative emotions, and enhance confidence in overcoming the disease.
Treatment of gastric cancer is not an overnight process. For elderly gastric cancer patients, it is important to take into account the age characteristics, acquire scientific care knowledge, encourage and guide patients to improve their motivation for treatment, and lay a good foundation for subsequent treatment as well as recovery.