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Clifford Ko, Janak Parikh, Irina Yermilov and James Tomlinson

Quality should be the right treatment for the right patient at the right time. In response to widely varying patient outcomes, national cancer organizations are emphasizing improvement in the quality of cancer care. The National Quality Forum, National Comprehensive Cancer Network, American Society of Clinical Oncology, and American College of Surgeons' Commission on Cancer, for example, have all defined quality measures and performed pilot projects to show how to measure and improve quality. Additionally, recent pay-for-performance initiatives have brought even more attention to quality improvement. Because cancer care is complex and multidisciplinary, surgeons must play an integral role in quality improvement. Providing good quality surgical care is essential and involves several considerations. This commentary discusses 6 of them. 1. Recognize the population People older than 65 years comprise the fastest growing population in the United States. The U.S. Census Bureau estimates that they will represent 13% of the population by 2010 and more than 50% by 2020. In 1999, they accounted for 40% of hospital discharges and 48% of inpatient care days.1 Because the risk for most cancers increases with age, this group represents a large cohort of patients who will need oncologic care. Moreover, this group of patients has unique issues, such as the need for evaluating their decision-making capacity, drafting of a living will or durable power of attorney, evaluation of functional status, need for assistance with activities of daily living (ADLs) postoperatively, and the management of polypharmacy. These issues, along with complex comorbidities, underscore the need for...