PALLIATIVE MEDICINE IN THE ELDERLY

Cancer is primarily a disease of the elderly and the palliation of bot h disease-and treatment-related symptoms is of importance in the pract ice of cancer medicine in all patients. Many older patients are treate d within community hospitals, in which anticancer therapies are less l ikely to be given and in which the palliation of symptoms should be of primary importance. Many oncologists struggle with the palliation of symptoms in patients who are near the end of life. This is despite the considerable energies that are spent in palliating symptoms in patien ts who are receiving anticancer therapies at all disease stages. The m anagement of pain has advanced considerably recently with improvements in pain assessment and pharmacologic interventions. However, elderly patients are less likely than younger patients to receive proper pain management. Elderly patients also are less likely to take opioids for pain because of their attitudes and beliefs. Fatigue, dyspnea, and psy chologic issues also are of importance in the management of elderly ca ncer patients both during anticancer therapy and near the time of deat h. Some elderly cancer patients die in the care of a hospice, although many are not referred to this service. There are many barriers to the provision of palliative medicine and these may be related to health p ractitioners, to the patients themselves, or to the health care system of which they are part. The increased educational efforts of health p rofessionals are needed to ensure that all patients, including the eld erly, have adequate palliation of their cancer-related symptoms. (C) 1 997 American Cancer Society.