Supporting and Treating the Older Adult with Cancer: It Starts in Primary Care

As I rapidly advance towards the geriatric age group, fears of cancer, in my case colon cancer because of a positive family history, start to increase. As a result, the unpleasantness of a recent colonoscopy was greatly alleviated later on by learning that I had no polyps or tumours. I am not alone in my concern about cancer, and the increasing prevalence of cancer as our population ages (and as age-corrected cardiovascular mortality declines) make these concerns quite legitimate. This high prevalence of cancer means that nearly all physicians--specialists as well as family physicians--who cares for adult patients will be caring for individuals with cancer in their practice. This issue’s focus on cancer in older adults allows us to address some of the learning needs of physicians caring for older adults with cancer.

Before her untimely death from breast cancer, a colleague of mine at the University Health Network wrote poignantly about the fatigue she experienced with her cancer. This taught me that as important as relieving pain is in cancer, many other symptoms are equally distressing for the patient. Our continuing education article this month is on some of these symptoms, and is titled “Fatigue, Pain, and Depression among Older Adults with Cancer: Still Underrecognized and Undertreated” by Dr. Manmeet Aluwhalia. An overview for supportive care of patients with cancer is addressed in the article ”Psychosocial Oncology for Older Adults in the Primary Care Physician’s Office” by Dr. Bejoy Thomas and Dr. Barry Bultz. Finally, in the same vein, is the article “Palliative Care in the Primary Care Setting” by Dr. Sandy Buchman, Dr. Anthony Hung, and Dr. Hershl Berman.

Our Cardiovascular Disease column this month is on “Diabetes and Cardiovascular Disease among Older Adults: An Update on the Evidence” by Dr. Pamela Katz and Dr. Jeremy Gilbert. Our Dementia column is on “Managing Non-Alzheimer’s Dementia with Drugs” by Dr. Kannayiram Alagiakrishnan and Dr. Cheryl Sadowski. One of the most important problems facing older adults, “Age-Related Hearing Loss,” is addressed by Dr. Christopher Hilton and Dr. Tina Huang. Urinary incontinence is usually considered a concern for older women; however, men are not exempt. Our Men’s Health column this month is on “Urinary Incontinence among Aging Men,” and is written by Dr. Ehab A. Elzayat, Dr. Ali Alzahran, and Dr. Jerzy Gajewski, who is a member of our partner association, the Canadian Society for the Study of the Aging Male. Dr. Gayatri Gupta and one of our international advisers, Dr. Wilbert S. Aronow, contribute an important article on "Prevalence of the Use of Advance Directives among Residents of a Long-term Care Facility" this month. Finally, it is imperative that physicians acknowledge the increasing prevalence of herbal medication use, which can lead to adverse drug interactions among their older patients. Dr. Edzard Ernst reviews this this topic in "What Physicians Should Know about Herbal Medicines.

Enjoy this issue.
Barry Goldlist