Treatment Decisions and Medical Treatment of Cancer in Elderly Patients
The current demographic changes will result in an increasing number of older people. Aging is the single most important risk factor for the development of cancer. The incidence and mortality rates of most malignant disorders increase substantially with in
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Relevance for Elderly Patients, Epidemiology Introduction The current demographic changes will result in an increasing number of older people. Aging is the single most important risk factor for the development of cancer. The incidence and mortality rates of most malignant disorders increase substantially with increase in age. Both developments combined result in an increasing number of elderly cancer patients (Smith et al. 2009). Whether behavior of malignant cells, such as growth rate or ability to metastasize, differs between tumors developed in a young or an old organism cannot be answered generally. Tumor biology can be more favorable, indifferent, or worse in elderly patients, depending on the kind of tumor. The population of old people is very heterogeneous. Individual resources and deficits are insufficiently described by chronological age
U. Wedding (*) Clinic for Internal Medicine II, Division of Palliative Care, University Clinics Jena, Erlanger Allee 101, 07740, Jena, Germany e-mail: [email protected] S.M. Lichtman 65+ Clinical Geriatric Program, Memorial SloanKettering Cancer Center, 650 Commack Road, Commack, NY 11725, USA e-mail: [email protected]
itself. Geriatric medicine established the comprehensive geriatric assessment (CGA) to describe these individual resources and deficits. Recent scientific trials addressed the question of whether the integration of CGA in the care of elderly patients with cancer improves diagnostic accuracy by a better description of patient-related prognostic variables and in the consequence clinical decision making and therapeutic outcome.
Epidemiology of Cancer Age is the major risk factor for the development of cancer. Table 1 reports the age-dependent increase of incidence and mortality rates in the U.S. population according to gender.
Current Situation of Care Registries for primary care report that in elderly people compared to younger ones 1. Primary prevention is less often addressed and performed, and 2. Cancer screening is less often addressed and performed. Cancer registries report that in elderly patients with cancer (Goodwin et al. 1986; Samet et al. 1986; Turner et al. 1999; Bouchardy et al. 2007), 1. The diagnosis is less often confirmed by histology, 2. The disease is more often diagnosed in advanced stage,
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_18, # Springer-Verlag Wien 2013
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Table 1 All cancer sites (invasive) Surveillance Epidemiology and End Result (SEER) incidencea and U.S. deathb rates, age-adjusted and age-specific rates, by race and sex All races Total Males SEER incidence Age at diagnosis Age-adjusted rates, 2004–2008 All ages 464.4 541.0 Under 65 223.8 219.1 65 and over 2,127.8 2,766.2 All ages (IARC 315.1 355.1 world std.)c Age-specific rates, 2004–2008
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