Cancer is a leading cause of death in the U.S. and around the world. Nearly two-thirds of those living with cancer are older adults. As policymakers look for ways to provide better care and greater value as a means to bend the cost curve, the nation's leading health policy journal, Health Affairs, is featuring a themed issue on cancer.

Many aspects of cancer care relate to breakthroughs in science—earlier detection, new medication regimens, and evidence of comparative effectiveness. Yet one aspect of care for the seriously ill is not routine: inclusion of patients and their goals.

I invite you to read a Narrative Matters I authored entitled, "Living Life In My Own Way--And Dying That Way As Well,” published in the April issue of Health Affairs. In it I discuss the patient's role, palliative care, and implications for health policy. While I am not an older adult, the people experiencing serious illness--like me--have a great deal at stake. I serve as one example that if we can do a better job of including patients in care decisions, we can have a profound impact on care, cost, and quality of life.

Older adults, especially those already battling other health issues, may be unwilling or unable to tolerate aggressive cancer treatments. Or, they may wish to attack their disease with every tool available. Either way, all older adults could benefit from an open dialogue to understand the risks and potential benefits of cancer treatments on their function, cognition, and quality of life.

Unfortunately, because few older adults are included in clinical trials, it often isn’t clear what those risks and benefits might be. That’s why, in 2007, the John A. Hartford Foundation began sponsoring a Cancer and Aging Work Group, with the goal advancing the field of geriatric oncology. The Hartford Foundation has supported dedicated researchers like Arti Hurria, a former Beeson scholar, who has been working to improve decision-making tools for oncologists treating older adults. I chose a palliative approach. For those facing serious illness, there are no wrong choices, only informed choices.