Careful Probing

AUDIO: 

All too often, health-care professionals ask elderly patients too few questions. At the recent International Society of Geriatric Oncology meeting in The Hague, a study was described in which one question was asked of 240 elderly cancer patients: Do you often feel depressed or sad? Only 50 of them answered yes. But when the same patients were asked more probing, detailed questions, at least a dozen more were found to be depressed. The single question was insufficiently sensitive.

Those treating elderly cancer patients realize that the older a person gets, the more likely loneliness may become a factor to reckon with. For those who have outlived friends and family or else live too far for regular contact, the hospital and medical staff may become the only network left.

Detailed questions, posed by a caring, knowledgeable team, are necessary to understand exactly what the elderly patient wants and expects. For an elderly patient with incurable lung cancer the issue is how to balance a potential small increase in survival time against treatment toxicity. I have had patients who have asked for less aggressive therapy and improved quality of life, even for a limited time. Virtually all patients will accept treatment if they know it will give them improved quality of life without undue toxicity.

Ideally, these are decisions that should be made by the doctor and patient working in concert. European geriatric oncologists report that, all too often, elderly cancer patients do not wish to participate actively in making their own decisions. At the conference, the physicians referred to their elderly patients as “the silent generation,” men and women who are accustomed to deferring to authority. The introduction of American baby boomers into the field, both as sons and daughters of elderly patients and then, in a few years, as the elderly patients themselves, will undoubtedly make this general passivity a thing of the past.