Cancer in the elderly: a societal perspective from the United States

Cancer is the second leading cause of death in the USA and will probably surpass heart disease, the current leader, over the next few years. As in other affluent nations, cancer in the USA is a disease of ageing, with a median age at diagnosis of 67 years. Moreover, men and women in average health who reach age 65 years will probably live an average of 20 more years and it is estimated that by 2025 20% of Americans will be 65 years and older compared with 12% of the present population. This will place an increasing burden on providers of cancer care and complicate the medical management of many elders. There is now great interest in educating primary care physicians about the management of cancer care of the elderly. Professional groups, such as the American Society of Clinical Oncology, the American Association of Cancer Research, National Cancer Institute-sponsored co-operative groups and the National Institutes on Aging, continue to support programmes to improve geriatric training of physicians and provide research money for those interested in geriatric oncology. Access to cancer care varies in the USA and older patients have not had the same standard of care as younger patients. This has probably resulted in poor outcomes for many. Also, clinical trial participation by elders has been poor. Several more recent trials focusing on older patients have been more successful, but accrual remains a major issue. Financial constraints have limited trial opportunities for elders and hopefully will improve in the future. A major challenge for those in North America will be to provide the health care for elders with cancer and other diseases in the coming years. To meet this challenge we must expand and train the number of health care providers at all levels.