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Aging and Cancer

Aging and Cancer

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.

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