A simple checklist could help doctors estimate whether an
older patient will be alive 10 years from now, according to a new study.
Researchers hope the findings, reported in the Journal of
the American Medical Association, will help older adults and their doctors
come to better decisions on health care.
There currently are national guidelines on medical
procedures like colon cancer screening and mammography screening for breast
cancer - but they give general guidance, not individual.
The checklist could help better tailor advice to older
patients, said lead researcher Dr Marisa Cruz.
"It's meant to be used in a clinical context, to help
doctors and older patients discuss screening and other interventions,"
said Cruz, a clinical fellow at the School of Medicine at the University of
California, San Francisco.
Guidelines based on averages
Guidelines on cancer screening tests and other interventions
vary, but they are based on averages. And some guidelines suggest age cutoffs
for screening, because there's a lack of evidence that the tests benefit the
average person past a certain age.
Colon cancer screening is one example. The US Preventive
Services Task Force, an independent panel that advises the federal government,
says that for most people, colon cancer screening should begin at age 50 and
continue only until age 75. Other groups, including the American Cancer
Society, do not give an upper age limit, but say doctors should consider an
older patient's overall health and life expectancy. For an elderly person in
poor health, an aggressive treatment or even a screening test could do more
harm than good.
On the other hand, a 75-year-old in good health could live
many more years, and may benefit from cancer screenings or aggressive
treatments, such as tight blood sugar control in people with diabetes.
Cruz said the checklist used in the new study aims to help
older adults get the tests or treatments that might benefit them, and avoid potentially
What it does not do, Cruz said, is give any one person a
"cut-and-dried prediction" of what will happen in the next 10 years.
How it was done
The researchers created the checklist based on data from a
national study of nearly 20 000 US adults older than 50. They found that 12
factors, considered together, can give an idea of an older adult's risk of
dying within 10 years.
Those include age, sex, weight, smoking and whether a person
has diabetes, lung disease, heart disease or physical limitations such as
difficulty walking a few blocks or moving large objects.
Doctors can get that information using yes-or-no questions,
and then assign points for each answer, Cruz said. If you're between 60 and 64
years old, for example, you get one point; if you're 65 to 69 years old, you
get two points.
People with a total score of one have, on average, a 5
percent chance of dying in the next 10 years. A score of five translates to a
23% chance of dying within a decade, while a score of 10 corresponds to a 70%
None of that is set in stone, Cruz said, but the scoring
system breaks people into "rough categories" of risk.
Having an idea of an older patient's life expectancy is
important because some medical interventions "take a long time to pay off,"
said Dr James Pacala, president of the American Geriatrics Society.
An idea from evidence
"Most cancer screenings, for example, take five to 10
years to pay off," Pacala said. For an older person unlikely to live that
long, the risks of screening - such as false-positive results, needless
invasive tests and anxiety - are likely to outweigh any benefit.
"If you care for older patients, this is something you
always have running in the back of your mind," Pacala said. "What is
the rest of this patient's life likely to look like?"
Right now, he said, doctors can get an idea by looking up
average life expectancy for a patient based on age and sex, and then
considering that person's overall health. The checklist in this study, Pacala
said, offers a more "formal" way to do that.
"This provides us with evidence-based numbers," he
Pacala stressed, however, that decisions on whether to
screen for or treat a disease should not be based solely on a number. He said
longevity estimates should be used to facilitate discussions between doctors
A doctor not involved in the study agreed.
"There is absolutely a need for better tools for
understanding life expectancy," said Dr Ethan Basch, an oncologist and
director of the cancer outcomes research program at the University of North
Carolina School of Medicine, in Chapel Hill.
But no life-expectancy calculator - or any single guideline -
is enough, Basch said. "This is one piece of information to help an older
patient make an informed, rational decision," he said.
Basch chaired the American Society of Clinical Oncology
committee that recently developed the group's guideline on PSA screening for
prostate cancer. The society suggests that doctors discuss PSA screening with
men who are expected to live for more than 10 years.
PSA screening is controversial because prostate cancer is
often slow-growing and will never threaten a man's life. Even if screening
catches a prostate tumor, many men may be treated unnecessarily.
For a man expected to live fewer than 10 years, the ASCO
says the potential harms of PSA screening seem to outweigh the benefits. For
men with a longer life expectancy, the group says things are not so clear-cut,
and having a conversation with your doctor might be worthwhile.
Learn more about screening tests from the US
Preventive Services Task Force.