Dr. B.J. Kennedy provides a general review of the impending collision between a poorly prepared health-care system and an aging population. As the older component of the population grows, critical management decisions will increase. The physiologic variability of the elderly population often results in ad hoc cancer management decisions that are poorly informed by the integration of knowledge between geriatricians and oncologists. As noted in the article, the incidence and prevalence of cancer will dramatically increase.
The Geriatrician vs the Oncologist
Oncologists make decisions based on evidence of efficacy in the detection and treatment of cancer—evidence generated from studies of younger populations. Geriatricians focus their efforts on "reducing disability and helping older people remain at home while recognizing the needs of family."[1] Although most oncologists view themselves as generalists, their primary focus is on cancer treatment. Geriatricians concentrate their efforts on the chronic diseases of the elderly (neurovascular, musculoskeletal, cardiorespiratory, and diabetes).
This article points out the desirability of collaborative research that focuses on the elderly. Research and educational cooperation between oncologists and geriatricians are minimal.
The Up-and-Coming ‘Geriatric Oncologist’
Some would quarrel with the designation of the title, "geriatric oncology," because in the coming decades, most oncologists will have to become more conversant with geriatric medicine. Assessments and interventions aimed at optimal patient care for the elderly will require some merging of applicable information.
Cancer research protocols often exclude the elderly through stringent eligibility criteria, citing abnormal laboratory values that may not always be relevant. Geriatricians are often suspicious of the ability of subspecialists, such as oncologists, to provide a holistic understanding of the concomitant problems facing older people.[2] The resultant lack of collaboration and shortage of these specialists have often made bilateral consultation difficult. The deficiency of meaningful prospective studies of the elderly with cancer contributes to the lack of good screening and management guidelines.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
