Watching 85-year-old Alfred Mezzei take his daily walk, it's hard to believe that he was diagnosed in May with esophageal cancer that had already spread.
"I won't get depressed," said Mezzei. "I never get depressed."
With that attitude, and his overall good health.
When deciding on treatment, the first thing Dr. Lodovici Balducci did was forget about his age.
"Mr. Mezzei may be 85-years-old in terms of his chronological age, but he's 65-years-old in terms of his physiological age," said Dr. Balducci. "He really is a young person."
While in the past, an 85-year-old man may have been considered too old to treat, new studies have shown that older patients can do just as well as younger people with aggressive cancer therapy. For Mr. Mezzei, that has meant a rigorous course of chemotherapy.
"First time I went up there, a piece of cake," said Mezzei. "It's been that way ever since."
Chemo is a piece of cake, and a chance for a quiet lunch, and it's working. Alfred's cancer seems to have gone on into remission.
At the Moffitt Cancer Center in Tampa, Lodovici Balducci believes that doctors need to learn how to treat cancer while at the same time, handle the multiple, chronic conditions of aging. And he's angry that the elderly are not included in clinical trials of new cancer drugs; even though they make up the majority of the patients.
Dr. Balducci thinks it's biased medicine against the elderly
Dr. Balducci says he's not trying to extend the life of cancer patients forever, but to prolong what he calls active life expectancy.
"It's to keep people in the best condition to enjoy what they enjoy doing," said Dr. Balducci.
Dr. Balducci's clinic is filled with warmth and caring, but there is also complete honesty, even with the worst news.
"You will experience more shortness of breath, more coughing," Dr. Balducci told one patient.
The lung cancer that 87-year-old retired judge John Lockman has been fighting for eight years is spreading again, and the outlook is grim.
"It may be time for hospice, and they will make sure you do not die in any discomfort," Dr. Balducci told Judge Lockman.
Dr. Balducci's honesty is appreciated and Judge Lockman is philosophical.
"At my age, I have no kick," said Judge Lockman. "How many people live to my age?"
Dr. Balducci is trusted at the end of life, because his patients know he helps them live their best life with cancer, no matter what their age.
"I told Dr. Balducci I'm not going to die of cancer, I'm going to die with cancer," said James Wheeler, laughing. "I'm going to die from tests."
Something else important to note: surveys show the majority of the elderly want to be treated aggressively for cancer.
Researchers want what they call clean trials, patients who are otherwise healthy, who don't have heart disease or diabetes, so they can figure out if the medicine is treating the cancer only. Dr. Balducci thinks every cancer trial should have an elderly population of patients in the trial as well.