Management of pain in older adults with cancer
Although the world is full of suffering, it is also full of the overcoming of it. – Helen Keller, Optimism (1903) Why focus on the elderly? Geriatric patients are complex, do not fit in the traditional biomedical model, and are underrepresented in cancer research trials; thus guidance for the practicing oncologist is not abundant, and myths and misunderstandings about older people are even more abundant. Why should the practicing oncologist give special attention to this population and their issues? First is the so-called demographic imperative. The fastest-growing segment of the U.S. population is the cohort who are greater than or equal to 65 years of age. Indeed, by the year 2030, this segment will comprise 20 percent of the U.S. population. Furthermore, the incidence of cancer in the United States dramatically increases with age, with a median age at diagnosis of 67 years and a median age at death of 73 years. Mortality rates show a dramatic difference by age if one is over 65 years of age, and the absolute number of deaths and the age at death have continued to increase from 1970 to 2002. At present, about 25 percent of new cancer diagnoses are in patients aged 65–74 years, about 22 percent in patients aged 75–84 years, and about 7.5 percent in those aged 85 years and older.
