Can one size fit all? Translating models of cancer survivorship care for older patients

摘要

There are currently 13.7 million cancer survivors in the USA [l]. As early detection and treatment options have grown, long-term survival has improved and the number of survivors is, therefore, projected to grow by 30% in the next 10 years [2], Since the majority of cancers occur in people over the age of 65 years, aging baby boomers will increase the total number of survivors in this group from 8 to 11 million by 2020 [3]. This trend is likely to cause increasing Medicare costs [4] and projected workforce shortages in both geriatrics and oncology [5,6]. Thus, rapid innovations are needed in the clinical management of older cancer survivors over the next decade to ensure the ultimate goal of high-quality and cost-effective cancer survivorship care [7]. Understanding whether current models of cancer survivorship care can be successfully adapted or customized for the elderly, given their often complex care needs, is an essential first step toward this overall goal. Providing comprehensive survivorship care to older adults can be challenging. Older adults are usually treated in the community, are rarely included in clinical trials and often present with competing illnesses that limit therapeutic options. Advancing age is associated with increasing functional dependency, increasing comorbidity and declining physiologic reserve.