Future Cancer Care Will CombineMedical/Social Solutions

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." Interdisciplinary Training 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 detection. 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 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, 1979). 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 approach."