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Introduction - Chapter 21

Chapter 21 - Social and Ethical Aspects

In western societies, about three-quarters of citizens will eventually become senior adults, meaning they will reach at least 70 years of age. They will have raised their family, many will have become grandparents, the vast majority will have retired from work, and almost all will be planning to enjoy their remaining lifetime in as good a general condition as possible.

However, when cancer knocks on the door of the elderly, it comes as a truly catastrophic event, exactly the same as when it happens to younger people; such bad news brings with it enough weight to put the life of the person in question in jeopardy, while the prospect of dying is quite logically closer and closer.

Many cancers though become chronic conditions, and their management may require serious additional resources. These may be limited by personal or societal realities because the cost of treatment will also have to be taken into account. Ageism may intervene to hinder appropriate management since it is an attitude frequently observed in both lay people and health professionals alike. It has been well demonstrated by multiple studies that cancers have a worse prognosis in senior adults than in younger patients.

Very soon, the third and fourth ages (65-80 and 80+) will represent about 20% of the entire population in low-income countries, and up to 30% in high-income countries. This calls for a rapid reworking of our respective social and health systems to preserve intergenerational solidarity, thus raising questions such as the following:

  • What space does society intend to leave to its most senior citizens?
  • How should the elderly behave to keep their current status safe?  
  • Or, which roles do senior adults want to play in their future?
  • When death approaches, is there a right time to die?

Medical oncologists are faced with the complexity of treating senior adults (elderly, older people) with cancer. If not lead and inspired by “The Hippocratic Oath”, which appears nowadays sometimes not in keeping with modern reality, they should at least be lead and inspired by the concept of dignity that is attached to every human being on earth regardless of the subject’s personal condition.

From the professional point of view, senior adults with cancer deserve the following (Figure).

The Ten Commandments of senior adult care “TRAFICCPAD”


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