Loren K. Mell, MD, Department of Radiation and Cellular Oncology, University of Chicago and the University of Illinois at Chicago, Chicago, IL, USA.

Arno J. Mundt, MD, Department of Radiation and Cellular Oncology, University of Chicago and the University of Illinois at Chicago, Chicago, IL, USA.

Radiation therapy (RT) is commonly used in the treatment of older cancer patients. RT may be used as definitive therapy for benign or malignant tumours, as adjuvant therapy with surgery and/or chemotherapy, as palliative therapy when cure is no longer possible, and as alternative to surgery in patients with multiple comorbidities. However, RT is often not given to older patients who might benefit from it, due to biases, misapprehensions about potential toxicity, and social factors particular to this patient population. The preponderance of data suggest that RT is well tolerated in older adults and treatment decisions should be based on prognostic factors irrespective of age. Emerging RT technologies may particularly benefit aged patients by reducing potential toxicities, shortening treatment times, and improving tumour control.

Key words: age, radiation therapy, toxicity, cancer, procedures.

Rory Fisher, MB, FRCP(Ed)(C), Professor Emeritus, Department of Medicine, University of Toronto, Toronto, ON.

Eoin Connolly, MA, Clinical Ethics Fellow, Joint Centre for Bioethics, University of Toronto, Toronto, ON.

Canada's aging population makes appropriate end-of-life care a priority. Alzheimer's disease and related dementias become increasingly common with aging. The terminal stages are characterized by severe cognitive and physical incapacity with a poor prognosis. Artificial nutrition and hydration may be provided by feeding tubes; however, there is no
evidence of benefit, and there are significant side effects to be considered. Barriers to appropriate end-of-life decision making are identified, and current evidence indicates that this patient population should be treated with appropriate palliative care.

Key words: Alzheimer’s disease, artificial nutrition and hydration, dementia, end-of-life care, ethics.

Paul B. Miller, BA, MA, MPhil, is a JD/PhD candidate in law and philosophy at the University of Toronto, and a Junior Fellow of Massey College in Toronto, Toronto, ON.
Trudo Lemmens, Lic Iur, LLM, is Assistant Professor in the Faculty of Law at the University of Toronto, Toronto, ON.

Lucrative Research
A pharmaceutical company invites Dr. B, a primary care physician, to assist with a placebo-controlled randomized clinical trial (RCT) of a new cholinesterase inhibitor for the treatment of dementia. The study will include patients who have been diagnosed with early-onset dementia. Dr B will receive $3,500 for each patient who ultimately agrees to enrol in the study. In the protocol, this fee is explained as payment of the administrative costs associated with Dr B's participation in the trial (in particular, as payment of "costs of obtaining informed consent, accumulating data, secretarial support, and consultation with each subject").

This hypothetical case illustrates an increasingly common phenomenon--offers of "finder's fees" and other "administrative" fees by pharmaceutical companies or Contract Research Organizations (CROs) to primary care physicians for conducting research involving their patients. Finder's fees are offers of money to physicians in reward for referral of patients eligible for research participation. They can be distinguished from payments made to cover costs of research participation.

Katherine Sheehan
University of St. Andrews,
St Andrews, Scotland.

Michael Gordon, MD, MSc, FRCPC
Vice President of Medical Services,
Baycrest Centre for Geriatric Care,
Professor of Medicine,
University of Toronto,
Toronto, ON.

The infection control troops are preparing for battle, waiting for the declaration of war. Once again, it's nearly time for our annual fight against the influenza virus. This potential killer affects hundreds of thousands of Canadians each year, leading to the hospitalization of 75,000 and resulting in 6,700 deaths. Of those who die, 90% are over the age of 65 and about half are residents of long-term care facilities. Elderly residents are particularly vulnerable because of their advanced age, underlying illness, close quarters with other residents and extensive contact with many caregivers.