At Any Age, All Patients Deserve Our Best

"The young man knows the rules, but the old man knows the exceptions."
-- Oliver Wendell Holmes

She looked younger than her 91 years, and now she had developed a cancer in her tongue. She certainly appeared healthy (she had made it to 91, after all) but I struggled as I weighed the risks and benefits of the treatment recommendations.

Would she tolerate the biopsies, scans, surgery and hospitalization? Frankly, I was not certain whether to recommend a major procedure. She set me straight. "Young man," she told me in no uncertain terms, "just take the cancer out. Do it as soon as possible." As it turned out, that was the right decision.

Often, probably too often, a physician's judgment will be unconsciously influenced simply because of a patient's age. In medical conferences, we routinely begin case presentations with statements such as, "This pleasant 61-year-old woman developed…" or, "This unfortunate 37-year-old man first noticed…" or, "This 55-year-old man was diagnosed with… "

Without a doubt, presenters and listeners work through a clinical dilemma differently if the scenario begins with, "This 96-year-old man…"

In a recent editorial in Cancer, Cornelius Granai urges us to abandon our "ageism" and to see patients outside of the context of how old they might be. All too often, patients are offered and accept less-than-ideal treatment simply because they are elderly. Physicians, as human beings, try to avoid difficult treatments that the elderly might indeed tolerate. Patients and families, too, might be pessimistic about treatments.

There are times when we possess the ability to treat effectively but we are stymied by our hesitancy to use the tools we have. As Dr. Granai points out, "half treatments, well intended as they are, rarely yield even half results." In our quest to spare patients of treatment's discomforts, we might deny them treatment's benefits.

The definition of "elderly" shifts depending on the health of the patient, the demographics of the population, the rigor of the therapy, and, frankly, the age of the physician. As we try to remember successes and seek to avoid therapeutic blind spots, it is important to recognize that risks increase with each of the patient's passing decades - but our presentations should focus on the cancer before the age of the patient. The elderly deserve the best of care. We all hope to get there someday.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, Froedtert & The Medical College of Wisconsin Cancer Center

Reference: Granai CO, "That certain age," Cancer 2005; 103:5.

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.