TY - JOUR
T1 - Cancer rates, medical comorbidities, and treatment modalities in the oldest patients
AU - Zeber, John E.
AU - Copeland, Laurel A.
AU - Hosek, Brandon J.
AU - Karnad, Anand B.
AU - Lawrence, Valerie A.
AU - Sanchez-Reilly, Sandra E.
N1 - Funding Information:
This research was supported by the Department of Veterans Affairs, including the VERDICT Research Program at the South Texas Veterans Health Care System, San Antonio, Texas. Dr. Sanchez-Reilly is supported in part by a grant from HRSA's Geriatric Academic Career Award and a VISN Grant from the Department of Veteran Affairs. Dr. Copeland is funded by VA Health Services Research and Development Career Development Award #MRP-05-145. We wish to sincerely thank Mary Jo Pugh, Ph.D., for her contributions to this study and insightful comments on this manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
PY - 2008/9
Y1 - 2008/9
N2 - Cancer disproportionately afflicts older patients, with 56% of incident diagnoses and 71% of deaths occurring in this population. Yet little is known about the "oldest of the old", oncology patients underrepresented in clinical trials. We examined elderly veterans diagnosed with lung, colorectal, prostate or head-neck cancer in 2005 (n = 194,797), analyses comparing treatment receipt by age group, 70-84 versus 85-115. Treatment was more common among younger elders, including surgery (1.3% versus 0.6%), chemotherapy (2.1% versus 0.8%) and radiation (1.7% versus 0.7%). Differences were sharper for certain cancers, e.g., chemotherapy for lung (9.0% versus 2.9%), or colorectal surgery (5.8% versus 3.4%). Cancer prevalence is high among elders yet treatment rates appear extremely low, despite evidence of well-tolerated treatment. Toxicity concerns and comorbidities may inhibit pursuit of definitive treatment. As we reconcile definitions of 'elderly' with appropriate treatment options, compassionate care requires identifying geriatric oncology guidelines that improve survival and quality of life.
AB - Cancer disproportionately afflicts older patients, with 56% of incident diagnoses and 71% of deaths occurring in this population. Yet little is known about the "oldest of the old", oncology patients underrepresented in clinical trials. We examined elderly veterans diagnosed with lung, colorectal, prostate or head-neck cancer in 2005 (n = 194,797), analyses comparing treatment receipt by age group, 70-84 versus 85-115. Treatment was more common among younger elders, including surgery (1.3% versus 0.6%), chemotherapy (2.1% versus 0.8%) and radiation (1.7% versus 0.7%). Differences were sharper for certain cancers, e.g., chemotherapy for lung (9.0% versus 2.9%), or colorectal surgery (5.8% versus 3.4%). Cancer prevalence is high among elders yet treatment rates appear extremely low, despite evidence of well-tolerated treatment. Toxicity concerns and comorbidities may inhibit pursuit of definitive treatment. As we reconcile definitions of 'elderly' with appropriate treatment options, compassionate care requires identifying geriatric oncology guidelines that improve survival and quality of life.
KW - Aged, 80 and over
KW - Epidemiology
KW - Medical oncology
KW - Neoplasms
KW - Radiation oncology
KW - Veterans
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U2 - 10.1016/j.critrevonc.2008.02.002
DO - 10.1016/j.critrevonc.2008.02.002
M3 - Review article
C2 - 18356072
AN - SCOPUS:48749119838
VL - 67
SP - 237
EP - 242
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
SN - 1040-8428
IS - 3
ER -