Cancer in the elderly: Research fails to keep up with demographic change

New research showing that almost half of 13,000 patients with head and neck cancers had other health-related problems at the same time is one of the presentations in a special session at the 31st conference of the European Society for Radiotherapy and Oncology (ESTRO 31) [1] today (Friday). The session will highlight the effect of the demographic time bomb caused by an increasingly ageing population.

Dr Charlotte Rotbøl Bøje, from the Aarhus University Hospital, Aarhus, Denmark, will tell the conference that analysis of co-morbidities – other medical conditions or diseases that exist alongside an initial cancer diagnosis – in 12956 patients registered in the DAHANCA database of all Danish head and neck cancers diagnosed between 1992 and 2008 found that 44% had at least one co-morbidity.

She will say that it is essential that doctors make a proper assessment of co-morbidities when deciding on the correct treatment for elderly patients with head and neck cancer. These patients are often long-term users of tobacco and/or alcohol, which, besides having a carcinogenic effect, can also cause lung, heart and cerebrovascular disorders.

The analysis by Dr Rotbøl Bøje and her colleague Professor Jens Overgaard found that the most common co-morbidities were cerebrovascular disease (11%), chronic pulmonary disease (11%), and cardiovascular disease (10%). Increasing age was significantly associated with co-morbidities, although there was no difference between genders. Survival rates and risk of death were also strongly associated with co-morbidities. The median age of the patients was 62; the youngest was 10 and the oldest 100. Men made up 73% of the total cohort. Information on co-morbidities was obtained from the National Patient Registry, which contains discharge diagnoses from all Danish hospital admissions and outpatient visits.

"Our analysis has shown how important it is to take a multidisciplinary approach to cancer in the elderly," says Dr Rotbøl Bøje, "particularly when recruiting them into trials. They will often have other medical conditions that need to be treated, and the design of trials needs to take this into account. We need trials that focus on both fit and frail elderly patients.

"There are some problems in treating older patients with radiotherapy, but this is not only due to their chronological age but also to the fact that there is more co-morbidity among the elderly. This can affect quality of life and can lead to treatment interruptions and hospitalisation. We believe that an accurate assessment of co-morbidities before starting treatment in elderly patients is essential in order to decide on the best and most appropriate treatment for this patient group."

In developed countries, half of all cancers already occur in patients aged 70 and over, and by 2050 the majority of older people will live in developing countries [2]. Yet the session highlighted not only the problem of co-morbidities but also how little research is conducted specifically into cancer patients over the age of 70 and the lack of clinical trials for this age group.