Future Cancer Care Will CombineMedical/Social Solutions

ATLANTA-New models forimproved social support are neededthat maximize the independence ofelderly cancer patients while decreasingcustodial health costs, accordingto the vice president of research for theAmerican Cancer Society."The future is going to require combinedmedical and social solutions,"said Jerome Yates, MD, MPH. "Andsome of the social and behavioral interventionsmay be more importantthan the medical solutions."Interdisciplinary TrainingThere are several ways that bettercombined medical/social care of elderlycancer patients might be achieved.One is through encouraging developmentof interdisciplinary training programsthat draw on the resources ofmedicine (community, academic, andprofessional organizations) and community(schools and public health).Such programs can produce providerteams trained in state-of-the-artcancer treatment and palliative care,and they could also help to inform theelderly about prevention and early cancerdetection.Likewise, interdisciplinary managementteams can provide coordinatedcare by drawing on the expertise ofmany different providers. "We needto change the reimbursement systemso we get interdisciplinary medicineplanning for some of these patients,"Dr. Yates said.Social SupportSocial support could be improvedin areas such as transportation, income,and home care. In particular,transportation is the "number one"problem many elderly cancer patientshave in accessing care, but transportationis costly and efforts to providetransportation for cancer patients havemet with "variable success," accordingto Dr. Yates.Many social support problemshinge on financial issues, particularlyat a time when health care costs areescalating and the sick elderly are consuminga disproportionate amount ofhealth care resources.In addition, many elderly patientshave limited opportunities for socialactivities and few people to rely on forhelp. This can lead to depression, pooradjustment to illness, and possibly increasedmortality. One epidemiologicstudy found the relative risk of mortalityfor isolated adults is 2.3 for menand 2.8 for women, compared to individualswho had the most social contacts(Am J Epidemiol 109:186-204,1979).Value the Role of the ElderlyAt a time of limited resources andfewer solutions than social-supportproblems, it may be time to "rethink"the role of the elderly in society, Dr.Yates said. "We need to invest in thegrowing compartment of elderly,much the same as we invest in ourchildren," he emphasized. "There arevery few communities where there is asignificant amount of money goinginto supporting the elderly."In turn, the elderly can contributein ways that previously were undervalued.For example, when Dr. Yatespracticed in Vermont, an elderly manwho had worked in the insurance industrycame in to the office once weeklyto explain insurance issues to patientsand their families."There are lots of benefits we getfrom our association with the elderlythat we don't pay much attention tobecause this society emphasizes theimportance of youth," Dr. Yates said."We tend not to use the life-developedtalents that older people have, but wecould do this if we took a systematicapproach."