Cancer in Older Persons: An International Issue in an Aging World

ArticleinSeminars in Oncology 31(2):128-36 · May 2004with29 Reads
DOI: 10.1053/j.seminoncol.2003.12.024 · Source: PubMed
Abstract
Persons age 65 years and older bear the greater burden of cancer in the United States and other industrial nations. A cross-national perspective using data from several population-based resources (eg, the NCI Surveillance, Epidemiology, and End Results Program; US Bureau of Census; World Health Organization; and International Association for Research on Cancer) illustrates current and future demographic transitions in America in comparison with six industrial nations, and profiles cancer mortality in older persons across the selected nations--Denmark, France, Italy, Japan, Sweden, and United Kingdom. Mortality rates, age-standardized to the world population, are presented for major tumors. US aging and cancer profiles are highlighted. Demographic projections portend a substantial increase in numbers of older persons, and thus, imply resultant increases in cancer incidence and mortality in the elderly. By 2030, there will be larger proportions of persons in the age group most vulnerable to cancer. Information is needed on how age-related health problems affect cancer prevention, detection, prognosis, and treatment. A knowledge base as guidance in management of cancer in the elderly is lacking. Planning for effective prevention measures and improvement of treatment for the elderly is imperative to meet current and future quality cancer care needs.
    • "In industrial nations, demographic projections portend a substantial increase in numbers of older persons, thus implying consequent increases in cancer incidence and mortality in the elderly [1]. Advanced age has been shown to be an important prognostic factor for survival in patients with brain metastases (BM) [2][3][4][5][6] . "
    [Show abstract] [Hide abstract] ABSTRACT: Background Advanced age has been shown to be a factor predicting poor survival in patients with brain metastases (BM). There have been only a few studies focusing on stereotactic radiosurgery (SRS) for elderly BM patients. The present study aimed to investigate the efficacy and limitations of SRS for very elderly BM patients. Methods This was a retrospective observational study analyzing 106 consecutive patients (69 males/37 females) age 80 years and older who received upfront Gamma Knife SRS for BM between January 2009 and October 2015. The median age was 84 years, and the median Karnofsky performance status (KPS) was 70. Fifty-two patients had a solitary BM, and others multiple BM. The median cumulative tumor volume was 3.9 mL and the median dose prescribed was 20 Gy. Overall survival (OS), neurological death rates and distant and local intracranial tumor control rates were analyzed. ResultsNo patients were lost to follow-up. Six-month and 12-month OS rates were 54% and 32%, respectively. The median OS time was 7.1 months. Competing risks analysis showed that 6-month and 12-month neurological death rates were 8% and 11%, respectively. In total, 245 / 311 tumors (79%) in 82 patients (77%) with sufficient radiological follow-up data were evaluated. Six-month and 12-month distant BM recurrence rates (per patient) after SRS were 17% and 25%, respectively. Six-month and 12-month rates of local tumor control (per lesion) were 94% and 89%, respectively. Repeat SRS, salvage WBRT and surgical resection were subsequently required in 25, 4 and 1 patient, respectively. Proportional hazard regression analysis showed that KPS ≥ 70 (HR: 0.444, P < .001), controlled primary disease/no extracranial metastases (HR: 0.361, P < .001) and female sex (HR: 0.569, P = 0.028) were independent factors predicting better OS. Similarly, tumor volume (>2 mL) was the only factor predicting a higher rate of local control failure (HR: 12.8, P = 0.003). Conclusions The present study suggested an upfront SRS strategy to offer a feasible and effective treatment option for very elderly patients with limited BM. In the majority of patients, neurological death could be delayed or even prevented.
    Full-text · Article · Dec 2016
    • "The only downside appears to be longer operative times, but data on elderly populations in surgical oncology remain scarce. Although endometrial cancer is the most common gynecologic malignancy in the western world, with increasing incidence, parallel to the aging demographics636465, only six published studies specifically address surgery in the elderly (Table 1). The data show improved benefits of MIS compared to open surgery in the elderly, similar to their younger counterparts [30,34,56,60]. "
    [Show abstract] [Hide abstract] ABSTRACT: An increasing proportion of patients requiring treatment for malignancy are elderly, which has created new challenges for oncologic surgeons. Aging is associated with an increasing prevalence of frailty and comorbidities that may affect the outcome of surgical procedures. By decreasing complications and shortening length of hospital stay without affecting oncologic safety, surgery performed using the robot, rather than traditional laparotomy, improves the chances of a better outcome in our growing elderly populations. In addition to age, surgeons should take into account factors, such as frailty and comorbidities that correlate with outcome.
    Full-text · Article · Jan 2016
    • "A cross-national comparison performed in 2000 showed that the proportion of individuals age ≥ 65 years was 12.6 to 18.1% [4], with the proportion predicted to reach 20–28% by 2030 [16]. Along with the growing size of the older population, the incidence of brain metastasis in elderly patients diagnosed with cancer has been rising for several reasons, including the longer survival of patients with a previously diagnosed localized cancer, and the improved detection of metastatic tumors by more sensitive imaging techniques. "
    [Show abstract] [Hide abstract] ABSTRACT: Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the survival of elderly patients after GKRS. The purpose of this study was to identify a scoring system that is able to predict the survival of elderly patients undergoing GKRS using data obtained at the time of diagnosis for brain metastases. Between 2004 and 2011, death was confirmed in 147 patients aged 70 years and older who had been treated with GKRS for brain metastases. Median age at the time of GKRS was 75.7 years (range, 70-86 years). The median tumor volume was 5.1 cm(3) (range, 0.05-59.9 cm(3)). The median marginal prescription dose was 21.4 Gy (range, 14-25 Gy). The median survival was 167 days. Overall survival rates at 6 months and 1 year were 60.4% and 29.4%, respectively. Among the patient characteristics pertaining to systemic cancer and brain metastasis for which data were obtained preoperatively, a multivariate analysis showed that low Karnofsky performance status (KPS ≤ 80, P = 0.047) and the presence of extracranial metastases (P = 0.014) detected at the time of brain metastasis diagnosis were independent prognostic factors for short survival. A high score index for radiosurgery (SIR score ≥ 4, P = 0.024) and a high graded prognostic assessment (GPA score ≥ 2, P = 0.004) were associated with longer survival. A multivariate analysis of the important characteristics of systemic cancer, and the scoring system evaluating survival duration showed that a low GPA score was the most powerful independent factor for predicting short survival (hazard ratio 1.756, 95% confidence interval 1.252-2.456, P = 0.001). GKRS is a safe approach to treat brain metastases in patients age 70 years and older. In this group, our study identified GPA score at the time of GKRS as a powerful prognostic factor for survival.
    Full-text · Article · Dec 2015
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