Cancer in older persons: an international issue in an aging world.
TL;DR: Current and future demographic transitions in America in comparison with six industrial nations are illustrated, and cancer mortality in older persons across the selected nations--Denmark, France, Italy, Japan, Sweden, and United Kingdom are profiles.
About: This article is published in Seminars in Oncology.The article was published on 2004-04-01. It has received 323 citations till now. The article focuses on the topics: Cancer prevention & Population.
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TL;DR: In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology, and it is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comor bidity.
Abstract: Background A number of studies have shown poorer survival among cancer patients with comorbidity. Several mechanisms may underlie this finding. In this review we summarize the current literature on the association between patient comorbidity and cancer prognosis. Prognostic factors examined include tumor biology, diagnosis, treatment, clinical quality, and adherence. Methods All English-language articles published during 2002-2012 on the association between comorbidity and survival among patients with colon cancer, breast cancer, and lung cancer were identified from PubMed, MEDLINE and Embase. Titles and abstracts were reviewed to identify eligible studies and their main results were then extracted. Results Our search yielded more than 2,500 articles related to comorbidity and cancer, but few investigated the prognostic impact of comorbidity as a primary aim. Most studies found that cancer patients with comorbidity had poorer survival than those without comorbidity, with 5-year mortality hazard ratios ranging from 1.1 to 5.8. Few studies examined the influence of specific chronic conditions. In general, comorbidity does not appear to be associated with more aggressive types of cancer or other differences in tumor biology. Presence of specific severe comorbidities or psychiatric disorders were found to be associated with delayed cancer diagnosis in some studies, while chronic diseases requiring regular medical visits were associated with earlier cancer detection in others. Another finding was that patients with comorbidity do not receive standard cancer treatments such as surgery, chemotherapy, and radiation therapy as often as patients without comorbidity, and their chance of completing a course of cancer treatment is lower. Postoperative complications and mortality are higher in patients with comorbidity. It is unclear from the literature whether the apparent undertreatment reflects appropriate consideration of greater toxicity risk, poorer clinical quality, patient preferences, or poor adherence among patients with comorbidity. Conclusion Despite increasing recognition of the importance of comorbid illnesses among cancer patients, major challenges remain. Both treatment effectiveness and compliance appear compromised among cancer patients with comorbidity. Data on clinical quality is limited.
431 citations
TL;DR: Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health, according to a retrospective review of data from 4 randomized trials.
Abstract: ContextAdjuvant chemotherapy improves survival for patients with local-regional
breast cancer, but healthy older patients at high risk of recurrence are frequently
not offered adjuvant chemotherapy, and the benefit of adjuvant chemotherapy
in older patients is uncertain.ObjectiveTo compare the benefits and toxic effects of adjuvant chemotherapy among
breast cancer patients in age groups of 50 years or younger, 51 to 64 years,
and 65 years or older.Design and SettingRetrospective review of data from 4 randomized trials that accrued patients
from academic and community medical centers between 1975 and 1999. Median
follow-up for all patients was 9.6 years. All trials randomized patients to
different regimens, doses, schedules, and durations of chemotherapy and all
had a treatment arm with doses or schedules that were regarded to be “high”
and potentially more toxic.PatientsA total of 6487 women with lymph node–positive breast cancer;
542 (8%) patients were 65 years or older and 159 (2%) were 70 years or older.Main Outcome MeasureComparison of disease-free survival, overall survival, and treatment-related
mortality among different age groups.ResultsMultivariate analysis showed that smaller tumor size, fewer positive
lymph nodes, more chemotherapy, and tamoxifen use were all significantly (P<.001) related to longer disease-free and overall survival.
There was no association between age and disease-free survival. Overall survival
was significantly (P<.001) worse for patients
aged 65 or older because of death from causes other than breast cancer. Thirty-three
deaths (0.5% of all patients) were attributed to treatment, and older women
had higher treatment-related mortality. Older women and younger women derived
similar reductions in breast cancer mortality and recurrence from regimens
containing more chemotherapy.ConclusionAge alone should not be a contraindication to the use of optimal chemotherapy
regimens in older women who are in good general health.
387 citations
TL;DR: Functional status assessed by the ADL score and malnutrition were independently associated with changes in cancer treatment.
Abstract: Purpose To identify Comprehensive Geriatric Assessment (CGA) components independently associated with changes in planned cancer treatment. Patients and Methods We prospectively included 375 consecutive elderly patients with cancer (ELCAPA01 study) assessed by geriatricians using the CGA. Multivariate analysis was used to identify factors associated with changes in the cancer treatment (intensification, decrease, or delayed > 2 weeks). Change was defined as a difference between the initial treatment proposal and the final treatment selected in a multidisciplinary meeting. Results Mean age was 79.6 years (standard deviation [SD], 5.6 years), and 197 (52.5%) were women. The most common tumor location was the digestive system (58.7%). The mean number of comorbidities was 4.2 (SD, 2.7) per patient, and the mean Cumulative Illness Rating Scale for Geriatrics score was 11.8 (SD, 5.3). After the CGA, the initial cancer treatment plan was modified for 78 (20.8%) of 375 patients (95% CI, 16.8 to 25.3), usually to d...
370 citations
TL;DR: While men are three to four times more likely to develop UCB than women, women present with more advanced disease and have worse survival rates, and Epidemiological and mechanistic molecular studies should be encouraged to design, analyse and report gender‐ and age‐specific associations.
Abstract: While patient age and gender are important factors in the clinical decision-making for treating urothelial carcinoma of the bladder (UCB), there are no evidence-based recommendations to guide healthcare professionals. We review previous reports on the influence of age and gender on the incidence, biology, mortality and treatment of UCB. Using MEDLINE, we searched for previous reports published between January 1966 and July 2009. While men are three to four times more likely to develop UCB than women, women present with more advanced disease and have worse survival rates. The disparity among genders is proposed to be the result of a differential exposure to carcinogens (i.e. tobacco and chemicals) as well as reflecting genetic, anatomical, hormonal, societal and environmental factors. Inpatient length of stay, referral patterns for haematuria and surgical outcomes suggest that inferior quality of care for women might be an additional cause of gender inequalities. Age is the greatest single risk factor for developing UCB and dying from it once diagnosed. Elderly patients face both clinical and institutional barriers to appropriate treatment; they receive less aggressive treatment and sub-therapeutic dosing. Much evidence suggests that chronological age alone is an inadequate indicator in determining the clinical and behavioural response of older patients to UCB and its treatment. Epidemiological and mechanistic molecular studies should be encouraged to design, analyse and report gender- and age-specific associations. Improved bladder cancer awareness in the lay and medical communities, careful patient selection, treatment tailored to the needs and the physiological and physical reserve of the individual patient, and proactive postoperative care are particularly important. We must strive to develop transdisciplinary collaborative efforts to provide tailored gender- and age-specific care for patients with UCB.
271 citations
TL;DR: It is demonstrated that comorbid health conditions disproportionately affect elderly cancer patients, with dementia and congestive heart failure the most common ailment in patients aged 74 and older.
Abstract: The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older. Although the prevalence and severity of comorbid ailments including dementia and congestive heart failure increased with age, some comorbidities such as HIV/AIDS and obesity decreased. Advances in cancer interventions have increased survivorship, but the impact of the changing prevalence and severity of comorbidities at different ages has implications for targeted research into targeted clinical and psychosocial interventions.
264 citations
Cites background from "Cancer in older persons: an interna..."
...[1,2] Yancik and Ries [3] that elderly patients currently account for 60% of incident tumors and account for 70% of cancer mortality....
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References
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TL;DR: Three elementary measures of cancer frequency are confined ourselves to: incidence, mortality and prevalence.
2,191 citations
TL;DR: This year's report contained a special feature focusing on implications of age and aging on the U.S. cancer burden.
Abstract: BACKGROUND
The American Cancer Society, the National Cancer Institute, the North American Association of Central Cancer Registries (NAACCR), the National Institute on Aging (NIA), and the Centers for Disease Control and Prevention, including the National Center for Health Statistics (NCHS) and the National Center for Chronic Disease Prevention and Health Promotion, collaborated to provide an annual update on cancer occurrence and trends in the United States. This year's report contained a special feature focusing on implications of age and aging on the U.S. cancer burden.
METHODS
For 1995 through 1999, age-specific rates and age-adjusted rates were calculated for the major cancers using incidence data from the Surveillance, Epidemiology, and End Results Program, the National Program of Cancer Registries, and the NAACCR, and mortality data from NCHS. Joinpoint analysis, a model of joined line segments, was used to examine 1973–1999 trends in incidence and death rates by age for the four most common cancers. Deaths were classified using the eighth, ninth, and tenth revisions of the International Classification of Diseases. Age-adjusted incidence and death rates were standardized to the year 2000 population, which places more emphasis on older persons, in whom cancer rates are higher.
RESULTS
Across all ages, overall cancer death rates decreased in men and women from 1993 through 1999, while cancer incidence rates stabilized from 1995 through 1999. Age-specific trends varied by site, sex, and race. For example, breast cancer incidence rates increased in women aged 50-64 years, whereas breast cancer death rates decreased in each age group. However, a major determinant of the future cancer burden is the demographic phenomenon of the aging and increasing size of the U.S. population. The total number of cancer cases can be expected to double by 2050 if current incidence rates remain stable.
CONCLUSIONS
Despite the continuing decrease in cancer death rates and stabilization of cancer incidence rates, the overall growth and aging of the U.S. population can be expected to increase the burden of cancer in our nation. Cancer 2002;94:2766–92. © 2002 American Cancer Society.
DOI 10.1002/cncr.10593
1,091 citations
TL;DR: Pisani, P., Parkin, D.M., Bray, F. and Ferlay, J. (1999).
Abstract: Pisani, P., Parkin, D.M., Bray, F. and Ferlay, J. Estimates of the worldwide mortality from 25 cancers in 1990. Int. J. Cancer, 83, 18-29 (1999). Due to a printer's error, incorrect table headings were entered in Tables II-IV after the proofs of the article had been approved by the author. The correct tables are reprinted on the following pages. The publisher regrets this error.
910 citations
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TL;DR: The Roman Catholic Church has shed its stance of opposition, or at best grudging accommodation, to democracy and in fact become a defender of human rights and government by consent as discussed by the authors.
Abstract: It is no accident that democracy first arose within the ambit of Western or Latin Christianity. Looking at Christianity and democracy around the world today, one sees that the Roman Catholic Church has shed its stance of opposition, or at best grudging accommodation, to democracy and in fact become a defender of human rights and government by consent. Protestants affirm democracy as well, and the world of Orthodoxy, while ambivalent, is leaning in a direction that essentially accepts democracy. In their attitudes toward politics and the public sphere at least, all faiths that embrace democracy also tend to undergo a certain "Protestantization."
725 citations
TL;DR: In this article, the authors provided an overview of aspects of the burden of cancer in the elderly, highlighting certain demographic and epidemiologic data, which served as a frame of reference for participants in the Oncology Geriatric Education Retreat, San Juan, Puerto Rico, February 21-26, 1997.
Abstract: Sixty percent of all cancer occurs in persons aged > or =65 years. This article provides an overview of aspects of the burden of cancer in the elderly, highlighting certain demographic and epidemiologic data. It served as a frame of reference for participants in the Oncology Geriatric Education Retreat, San Juan, Puerto Rico, February 21-26, 1997. Information comes from several major sources: U. S. Bureau of the Census; National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; National Center for Health Statistics; National Institute on Aging (NIA)/NCI SEER Study on Comorbidity and Cancer in the Elderly; and NCI cancer prevalence estimates. Data on the aging population demonstrate an unprecedented expansion of the segment of the population aged > or =65 years. By 2030, 1 in 5 Americans will be aged > or =65 years. Because cancer incidence and mortality rates are highest in persons aged > or =65 years, expansion of this age group takes on great importance for medical professionals who provide treatment to older aged cancer patients. In addition, older aged cancer patients are likely to have preexisting conditions at diagnosis, creating a special clinical challenge. There is an urgent need to better understand the influence of aging on the early detection, diagnosis, and treatment of cancer. Clinicians who treat older persons (geriatricians, oncologists, and other health professionals) can benefit from the integration of the knowledge and approaches of each others' fields. The foundation for this multidisciplinary effort is linked with the education and training of future clinicians.
519 citations