Complicated and complex: the management of older cancer patients, a frame of reference to approach clinical complexity

In this article, we propose a frame of reference to approach complexity in clinical practice. Complexity is becoming a more and more common issue, due to the aging of the population, increased prevalence of polymorbidity, dwindling pool of home caregivers, and the social and economic issues associated with age. The case of a 79-year-old woman with hemiparesis from a previous stroke, breast cancer, and chronic myelogenous leukemia is analyzed. From the analysis of the case, we concluded that: there was an urgent need of a person charged with making the final medical recommendations to an older individual with multiple medical problems; patient autonomy may be limited by the need of a caregiver able to assist in the activity of daily living; active life expectancy is a major goal in the management of an older person; several courses of actions may be acceptable toward such goal.