ATith the crisis we are experiencing in the hospital, our daily lives force us to do more with fewer resources. So let’s be innovative! The aging of our population, which is an unprecedented opportunity in our history, obliges us. The example of caring for elderly patients with cancer is very illustrative of the ills of our health strategy.
With a compartmentalized system, where care pathways too often rhyme with a succession of care acts, without integrative capacity, the cross-complexity of cancerous diseases, their treatments, and age, leads to a lack of efficiency. With its share of suffering for our patients. About 60% of cancers occur after age 65 and 30% after age 75. Being somewhat caricatural, we can say that cancer is a disease of age.
However, the elderly person by nature requires an individualized and integrative (medico-psycho-social) approach to his care. This is true at any age, but it is imperative for our elders. Our health system, built on the cult of so-called “organ” medicine, of the overvaluation of technical medicine, is lacking in its ability to reform its organization to adapt to the challenge of aging and the chronicization of diseases. And cancer represents a model in itself, so that we, actors of care, modify our practices and, beyond that, our culture in health.
Build an adapted life course
Currently, the curative, exclusive vision is still too marked, while the issues of quality of life and autonomy are now at least as important. Wanting to heal at all costs is not compatible with the specificities of aging. Moreover, the civil age is not a sufficient criterion, alone, to decide not to treat a patient with an ambition of cure. This is why, for many years now, geriatric oncology specialties have learned to work together, in order to define the most relevant strategies based on a holistic assessment to be offered to the patient (who ultimately decides). If this cooperation is effective, it is now confronted with the difficulty on the ground of the lack of integrative organization of our health system.
The recommendations of CAP think tank (Priorities Age Cancer) are made to meet this challenge. The first is to rethink the cooperation of professionals in the course of care by generalizing the identification of fragile patients by this systematic medico-psycho-social gerontological evaluation. The second recommendation is precisely to build a life course adapted to the elderly patient with cancer, by positioning coordination professionals at the heart of the system. Advanced practice nurses (APNs), a new profession, will be the key players for this mission.
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