Barry Goldlist, MD, FRCPC, FACP
Last year as I was watching the National News on CBC, I was treated to a classical good news, bad news medical scenario by Peter Mansbridge. The first report was the good news; the proportion of deaths each year in Canada caused by cardiovascular disease was declining. The bad news was that the proportion of deaths caused by cancer was increasing. I felt like screaming "Peter, of course. It has to add up to 100% each year, if one goes down another has to go up!" However, in truth it is not just an issue of proportion. The prevalence of cancer is clearly rising in western society, and the reason is very straightforward. Old age is the major risk factor for many types of cancer, and our society is aging.
This has led to a tremendous growth of research concerning cancer in the elderly, and into the fundamental connection between aging and cancer. I am not confident, however, that the clinical care of elderly cancer patients has been influenced by recent advances in geriatric medicine. In the United States, many medical oncology training programs have started to include geriatric modules in their curriculum. I am unaware of this occurring in Canada. Although the wards of cancer hospitals now have a high proportion of frail elderly in their beds, few hospitals have advanced practice nurses with expertise in geriatrics to help in the nursing management of these patients. Geriatric medicine consultations are very uncommon, and even more importantly, formal programs to rehabilitate elderly people after aggressive therapy (surgery, radiation, chemotherapy), do not currently exist. The Health Services Restructuring Commission in Ontario, to its credit, recognized this deficit and mandated the newly formed Toronto Rehabilitation Institute to develop an oncology rehabilitation program. The funding and success of programs such as this might have a great impact on the quality of life of elderly cancer patients in the future.
