RESUMO
Cancer disproportionately afflicts older patients, with 56% of incident diagnoses and 71% of deaths occurring in this population. Yet little is known about the "oldest of the old", oncology patients underrepresented in clinical trials. We examined elderly veterans diagnosed with lung, colorectal, prostate or head-neck cancer in 2005 (n=194,797), analyses comparing treatment receipt by age group, 70-84 versus 85-115. Treatment was more common among younger elders, including surgery (1.3% versus 0.6%), chemotherapy (2.1% versus 0.8%) and radiation (1.7% versus 0.7%). Differences were sharper for certain cancers, e.g., chemotherapy for lung (9.0% versus 2.9%), or colorectal surgery (5.8% versus 3.4%). Cancer prevalence is high among elders yet treatment rates appear extremely low, despite evidence of well-tolerated treatment. Toxicity concerns and comorbidities may inhibit pursuit of definitive treatment. As we reconcile definitions of 'elderly' with appropriate treatment options, compassionate care requires identifying geriatric oncology guidelines that improve survival and quality of life.
Assuntos
Neoplasias Colorretais , Neoplasias de Cabeça e Pescoço , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Neoplasias Pulmonares , Neoplasias da Próstata , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/terapia , Terapia Combinada , Comorbidade , Estudos Transversais , Feminino , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Incidência , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/terapia , Masculino , Prevalência , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/terapia , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricosRESUMO
The purpose of this study was to assess the impact of an elective geriatric palliative care course on medical students' attitudes, knowledge, and behaviors regarding communication with terminally ill patients. Surveys were administered at the beginning and end of the elective. Despite a significant increase in knowledge about geriatric and palliative medicine (F=24.80; P<.001), there were no significant changes in students' self-reported behaviors when applying curriculum-based communication strategies. However, the qualitative analysis of open-ended questions showed that the curriculum intervention did result in an improvement in empowering message strategies for breaking bad news. The evaluation of the end-of-life curriculum needs to exceed the measurement of attitudes and knowledge and include behavioral assessment of end-of-life communication skills.