ATLANTA-New models for
improved social support are needed
that maximize the independence of
elderly cancer patients while decreasing
custodial health costs, according
to the vice president of research for the
American Cancer Society.
"The future is going to require combined
medical and social solutions,"
said Jerome Yates, MD, MPH. "And
some of the social and behavioral interventions
may be more important
than the medical solutions."
There are several ways that better
combined medical/social care of elderly
cancer patients might be achieved.
One is through encouraging development
of interdisciplinary training programs
that draw on the resources of
medicine (community, academic, and
professional organizations) and community
(schools and public health).
Such programs can produce provider
teams trained in state-of-the-art
cancer treatment and palliative care,
and they could also help to inform the
elderly about prevention and early cancer
Likewise, interdisciplinary management
teams can provide coordinated
care by drawing on the expertise of
many different providers. "We need
to change the reimbursement system
so we get interdisciplinary medicineplanning for some of these patients,"
Dr. Yates said.
Social support could be improved
in areas such as transportation, income,
and home care. In particular,
transportation is the "number one"
problem many elderly cancer patients
have in accessing care, but transportation
is costly and efforts to providetransportation for cancer patients have
met with "variable success," according
to Dr. Yates.
Many social support problems
hinge on financial issues, particularly
at a time when health care costs are
escalating and the sick elderly are consuming
a disproportionate amount of
health care resources.
In addition, many elderly patients
have limited opportunities for social
activities and few people to rely on for
help. This can lead to depression, poor
adjustment to illness, and possibly increased
mortality. One epidemiologicstudy found the relative risk of mortality
for isolated adults is 2.3 for men
and 2.8 for women, compared to individuals
who had the most social contacts
(Am J Epidemiol 109:186-204,
Value the Role of the Elderly
At a time of limited resources and
fewer solutions than social-support
problems, it may be time to "rethink"
the role of the elderly in society, Dr.
Yates said. "We need to invest in the
growing compartment of elderly,
much the same as we invest in our
children," he emphasized. "There are
very few communities where there is a
significant amount of money going
into supporting the elderly."
In turn, the elderly can contribute
in ways that previously were undervalued.
For example, when Dr. Yates
practiced in Vermont, an elderly man
who had worked in the insurance industry
came in to the office once weekly
to explain insurance issues to patients
and their families.
"There are lots of benefits we get
from our association with the elderly
that we don't pay much attention to
because this society emphasizes the
importance of youth," Dr. Yates said.
"We tend not to use the life-developed
talents that older people have, but we
could do this if we took a systematic