to the editor: The article by Smith and Hillner is provocative and timely. However, one critical area not discussed is the growing financial burden of caring for older patients. Although we accept that any consideration of restricting treatment on the basis of age alone is uncomfortable for many clinicians, we feel that a dialogue regarding the value of treating elderly patients needs to be initiated. Pivotal to this discussion, however, is the availability and careful analysis of comprehensive data regarding outcomes in routine care; this analysis should be used to inform practice along with the subgroup analyses involving the select older patients enrolled in clinical trials,which currently largely determine standards.
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