Re: Cost of care for the elderly cancer patients in the United States.

We thank Yabroff et al. ( 1 ) for highlighting the cost of care for elderly cancer patients in the United States. With the growth and aging of the US population, the prevalence of cancer will increase, as will the cost of cancer care to the Medicare program. This study highlights the need to develop more age-appropriate treatment protocols that take into account health-related quality of life and psychological well being, as well as physical outcome measures. The authors found that the costs of care varied by tumor site, phase of care, stage at diagnosis, and survival. Although segmenting the costs by the above factors may help to project the impact of interventions to improve prevention, screening, and treatment on costs of care and survival, we would like to put forth individualized care as the key to optimal outcome with potential lower costs. The aging population is diverse in terms of life expectancy and treatment tolerance, but this diversity is poorly refl ected in chronologic age. A more reliable assessment of physiologic age may be obtained by a comprehensive geriatric assessment that involves function, comorbidity, nutritional, social, and economic needs ( 2 ). In addition, a comprehensive geriatric assessment may unearth conditions, such as malnutrition, mild memory disorders, inadequate care provided by a caregiver (which may compromise access to care), and treatment outcome ( 3 ). Older patients with cancer have been shown to be more likely to require functional assistance than those without cancer ( 4 ). Since its beginning, the Geriatric Oncology Consortium has designed clinical trials for older individuals that are based on physiologic rather than chronologic age. The Geriatric Oncology Consortium and the National Comprehensive Cancer Network also recommend that all individuals aged 70 years or older should undergo a basic comprehensive geriatric assessment before any form of cancer prevention and cancer treatment is initiated. The small investment in the comprehensive geriatric assessment, which has already proved extremely useful in preventing functional decline in older individuals, may result in saving a substantial amount of money by selecting patients who are most likely to benefi t from antineoplastic treatment and by preventing serious and costly therapeutic complications. Because most of our current treatments will benefi t the patient overall, they will also produce some measure of adversity. For older cancer patients, many of whom may be affected by comorbid health conditions such as heart disease, diabetes, and arthritis, adverse effects from cancer treatment can have a profound impact on their heath and quality of life. Thus, we strongly encourage the incorporation of comprehensive geriatric assessment into research studies for older patients with cancer to improve our ability to individualize treatment and improve the outcome of older patients with cancer. The Geriatric Oncology Consortium ( www.thegoc.org ), an organization created to focus on advancing geriatric oncology research, and the H. Lee Moffi tt Cancer Center consider one of our research priorities to incorporate geriatric assessment into research trials and to assess its impact on the costs of care in the older cancer population. Geriatric oncology is a fi eld with much room for research and education and will be one of the greatest challenges of this century.