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GUEST EDITORIAL |
Dr. Bennett is Guest Consulting Editor for Geriatric Oncology and Professor of Medicine Emeritus of Pathology & Laboratory Medicine at the University of Rochester Medical Center, Rochester, NY.
Although cancer remains a significant cause of mortality at all ages and is the second most common cause of death after heart disease, its burden is felt disproportionately in our older citizens.1 The majority of cancers occur in adults over the age of 65, with about 70 percent of all cancer deaths in this population.2
By the year 2030 conservative projections indicate that 70 million Americans will be over the age of 65 years. This latter statistic is the result of a significant increase in the life expectancy in the United States. Women can expect to live, on the average, to age 85, and men, to age 77. Of even more importance is that individuals who are alive and healthy in their seventies can expect to live an additional 10 to 15 years.3
The implications of these facts are significant and raise important medical, social, ethical, and public health issues. Although there has been considerable progress in the treatment of certain malignancies such as acute lymphocytic leukemia in children, Hodgkin’s disease, testicular cancer, and some of the non-Hodgkin’s lymphomas, with a resultant decrease in cancer mortality under age 60 years, there has been less impact on the major "solid" tumors such as lung, colorectal, and breast cancer.4 Certainly early detection and adjuvant therapy should improve the outcome if made available to older individuals at risk.
Unfortunately there is ample evidence that care providers are ill equipped to handle the complex management issues of the older patient at risk for cancer or who has had a cancer diagnosis established. What has been referred to as "age bias" affects the decision to refer patients for preventive strategies or even for therapy.5 Understanding the physiologic age of a patient for potential therapeutic considerations as well as the social/economic/mental burdens that exist requires a time and effort commitment that may exceed the normal "allowable" office-visit time and reimbursement available.
With the assistance of the John A. Hartford Foundation our group at the University of Rochester has initiated a pilot program at 12 medical centers to develop a combined medical oncology/geriatric fellowship program. By cross training these specialists we hope to take advantage of the considerable opportunities that exist nationally from the National Institutes of Health, the American Cancer Society, and private agencies in prevention, early detection, diagnosis, and case management.
The products of these programs will become the geriatric oncology researchers and teachers of our care providers.6 A vastly expanded program has been initiated through the American Society of Clinical Oncology. With a grant from the Hartford Foundation we anticipate awarding up to seven centers in the year 2002 that will permit a greatly expanded program for geriatricians and medical oncologists to promote clinical training and research through a cooperative effort.
At the University of Rochester’s James P. Wilmot Cancer Center we will be initiating a multidisciplinary consult service for patients over age 75 with an established diagnosis of cancer to determine whether they are suitable candidates for a variety of interventions. This is an example of numerous strategies that could become available with a new generation of trainees and dedicated faculty.
In this issue of CA we are pleased to introduce the first of a series of articles that will focus on the geriatric patient at risk for cancer or who has had a cancer diagnosis established. Dr. Jerome Yates, Senior Vice President for Population Services and Health Services Research at Roswell Park Cancer Institute in Buffalo, NY, has had a long-standing interest in comorbidity and its assessment and impact on decision-making. His article "Comorbidity Considerations in Geriatric Oncology Re-search7" is timely and meaningful in light of the above discussion. We plan to have additional papers address many other issues that are of importance to the readers of CA, who will be faced with the ultimate responsibility of being decision-makers, since they are the gatekeepers of our older citizens.
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