Richard Fisher of Marion County, Ohio, first received a colon cancer diagnosis about seven years ago at the age of 68. After he noticed some blood in his stool, a colonoscopy revealed he was in the advanced stages of the disease.
"The doctor told me he didn't care if I got treatment or not because either way I only had six months to live," the retired farmer and construction worker recalled.
Fisher said he felt the doctor wrote him off, mostly because of his age. It seemed like he never considered that someone approaching 70 would be able to survive the aggressive treatment needed to bring his condition under control, Fisher said.
After the initial shock wore off, the Fisher family took action. One of his three daughters had a friend who worked at the Ohio State University Comprehensive Cancer Center in Columbus. She put in a call and got him an appointment.
Right from the start, Fisher said he knew he was in the right place. The medical team immediately began his treatment. First he had surgery, then intensive chemotherapy.
There were a lot of highs and lows during that first phase of care, Fisher admitted, but he got through it. He was virtually cancer-free for almost two years before the initial drugs lost their potency. The Ohio State team then switched him to a new chemo drug that allowed three more years of good health. Once those stopped working about two years ago, he opted to try experimental treatment as part of two separate clinical trials.
"In the seven years I've had treatment, no one at OSU has ever given us a time limit like that first doctor," his wife Martha Fisher said. "It's wrong to tell anybody, even if they're 70, 80 or 90 that you have a time limit on your life."
Treating Older Patients
Dr. Richard Goldberg, one of Fisher's doctors, a gastrointestinal medical oncologist and physician in chief at OSU, said doctors are beginning to realize that just because someone has celebrated a lot of birthdays doesn't mean they can't withstand the rigors of cancer therapy.
"As we gain more experience, doctors are learning we can do pretty big procedures on older people and if they are healthy and active we can get them through just fine," Goldberg said.
Goldberg said that many of his older patients have responded surprisingly well to cancer treatment and, have gone on to lead full and active lives for years afterwards. It helps that many of them are also willing to consider enrolling in clinical trials that study the benefits of experimental drugs.
"I'm very glad I've participated in the clinical trials," Fisher said. "I enjoyed a lot of life in the last seven years and I feel happy to help those who come later."
Fisher said he's hopeful the combination of chemotherapy and other drugs he's been taking in this latest clinical trial are working. He's gained weight and feels stronger than he has in several months. Goldberg will test him in a few weeks to see whether the cancer is still growing or has stopped advancing.
However, Goldberg said there are inherent challenges to treating aging colon cancer patients.
Because there are few studies demonstrating how seniors respond to chemo drugs and other therapies, doctors are sometimes reluctant to try the full dose of standard treatment protocols. The few studies that have been done suggest that colon cancer patients in their seventh decade and beyond may not respond as well to treatment as younger patients.
But Goldberg said doctors need to get a handle on treatment options for senior colon cancer patients because they are the ones at greatest risk. Overall, 90 percent of new cases of colon cancer and 94 percent of deaths occur in individuals 50 and older, according to the National Cancer Institute. The incidence rate of colorectal cancer is more than 15 times higher in adults 50 years and older than in those who are younger.
Goldberg said it is also important to treat each patient as an individual regardless of age.
Other than cancer, Fisher had few health problems which made him a good candidate for treatment. Goldberg said it helped that he was fully engaged in discussions about his care and had a strong support system in his wife Martha and his three grown daughters, Christine, Sherry and Julie.
And as Goldberg noted, Fisher was motivated to push through the hardships. Before Fisher became his patient, Goldberg used to ride his bike past his house and admire the neatly manicured lawn, impressive vegetable garden and well-appointed workshop.
"When I met him and realized this was his house, it all made sense," Goldberg said. "This was a guy who had goals and a lot to live for."
The American Cancer Society estimates that in 2013 there were about 140,000 people diagnosed with colorectal cancer and nearly 50,000 of them will die of the disease in the U.S. In both men and women, colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death.
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