As a retired elderly (soon to be 83-year-old) oncologist, I read the recent article on the subject of geriatric oncology, in the March 15 issue of The ASCO Post, with great interest ("Moving the Field of Geriatric Oncology Forward," by Stuart M. Lichtman, MD, FACP, FASCO.) This was particularly so because I have recently been treated for two separate cancers, early in their course and hopefully cured.
I have long given thought to the definition of elderly with regard to treatment of cancer. I have come to the conclusion that there is no useful definition that addresses this time of life for an individual patient. Aging has two components: chronology and biology. They do not necessarily reflect the same stage of an individual’s life. During the course of nearly 50 years of caring for patients, I have seen people in their 60s who could "biologically" be considered to be in their late 80s, and others who, in their 80s, could biologically fit a group in their 50s or 60s.
It seems to me that we need an index of biologic aging, just as there is a Karnofsky index for the biologic functionality of younger cancer patients. Such an aging or maturity index could be used in the evaluation of the applicability, intensity, and value of a given cancer treatment in such individuals, rather than treatment decisions being made more arbitrarily.
It is possible that such an index already exists, but if so, I have not read about its application to the growing problems of geriatric oncology. I hope this message may be of some value in furthering this increasingly important field of clinical investigation. ■
—Ernest Greenberg, MD
New York, New York