Cancer control and the older person: an overview

Article Abstract:

Cancer is primarily a disease of older people. Half of all cancer patients are over 67 years, and 85 percent of the new cancers diagnosed in 1990 involved patients over 50 years. Nevertheless, cancer screening programs tend to focus on younger people, and indeed primary care physicians appear to be less aggressive in promoting prevention, early detection, and effective treatment among their older patients. Unfortunately, there seems to be an attitude among relatives and physicians that cancer among the elderly is inevitable. For example, about 45 percent of breast cancers occur in women over 65 years, and it is estimated that death from breast cancer in this age group could be reduced by 30 percent with more mammographic screening. Data indicate that women should continue to have mammographic examinations until at least 75 years of age, although it may be possible to reduce the frequency of exams to every two years. Similarly, colorectal cancer screening can reduce the risk of death, perhaps by as much as 60 percent; some researchers feel that screening for colorectal cancer should continue to age 75. When cancer is discovered, physicians should not be overly cautious. While it is true that older patients tend to be more susceptible to the side effects of treatment, they are still likely to respond favorably. Caution should not result in the undertreatment of the elderly cancer patient. Economic factors also play a role in the medical care of the elderly; as of 1988, 28.5 million elderly in the United States lived in poverty and were probably not receiving adequate medical care. Many of the elderly who are not poor by definition are nevertheless living on fixed incomes which may adversely affect their health care. Concerned about these problems, the American Cancer Society hosted the Workshop on Cancer Control and the Older Person in March of 1991. Cancer researchers, physicians, sociologists, and other professionals concerned with cancer care met to discuss how the five priorities of the Society's basic mission can be met for older people. These priorities are primary cancer prevention, detection and treatment, patient service, research, and public policy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Cancer control and the older person: psychosocial issues

Article Abstract:

Psychological and social issues affect the prevention, diagnosis, and treatment of cancer among people of all ages, including the elderly. Unfortunately, there are few data that clarify the most important psychological and social issues involved in these aspects of health care. However, some important principles can be outlined; they not only identify notions that the elderly hold about cancer, but also reveal notions that the medical community holds about the elderly. One basic concept to be learned is that people ''over 65'' are not a homogeneous group, and must not be treated as such, either for research purposes or for treatment. In addition, it should be clear that a 67-year-old patient and a 97-year-old patient reflect vastly different degrees of age, despite both being ''over 65''. Older patients often visit physicians only for specific complaints, and may not have routine physical examinations. It is important for physicians to realize that important opportunities for the detection of cancer may be missed. Furthermore, there is some indication that older people may be less inclined to notice and report symptoms of cancer when the disease is in its earliest stages. A new symptom might be merely attributed to the effects of advancing age, and not recognized as an indication of a more serious illness. Many facets of cancer detection and treatment among the elderly are deserving of further research. It is important to determine why the elderly consult physicians when they do; if physicians spend sufficient time with their elderly patients; and if the patterns of communication between physician and patient affect the use of health care. It may be possible to identify social and psychological factors that not only help older people to be better informed about cancer risks and the need for prevention and early detection of cancer, but also help older people to be more assertive in demanding appropriate health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Medical care

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Advocacy: necessary to achieve cancer control goals

Article Abstract:

One of the mandates recognized by the American Cancer Society is to take a position of advocacy to influence public opinion and government policy in ways that will improve cancer prevention, detection, and treatment. One domain in which advocacy is important is in the control of cancer among the elderly. Cancer is far more common among older people, but many factors impede the optimal delivery of services to this population. Older patients (as well as many younger ones) view the physician as an authority figure. The physician's advice is not to be questioned, and many patients do not wish to risk alienating their physician by asking serious questions about their own health care. One appropriate target of advocacy is clearly the education of elderly patients, as well as their physicians and caregivers. One of many other targets for advocacy is the development of a higher priority for oncology at the Geriatric Education Centers which have been instituted for young physicians in the US. It is also certain that advocacy is absolutely required for many elderly patients who are not receiving adequate cancer care, as well as adequate care for other problems. These elderly consist of the poor, minorities, the illiterate, those with language barriers as well as those who are incapacitated by extreme age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Political aspects, Social medicine

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