Cancer in nonagenarians: profile, treatments and outcomes

An increasing number of nonagenarians are treated for cancer. However, very few data are available to guide treatment choices in this often frail population. The charts of all patients registered at Moffitt Cancer Center between 1993 and 2006 who were aged 90 or older at the time of treatment/evaluation were reviewed, and those treated for an active cancer (n=177) were included in the analysis. For 23.5% of patients, the index cancer was a second malignancy. Initial treatments were: surgery 41%, chemotherapy 9%, radiation therapy 15%, concomitant chemo-radiation therapy 2%, hormonal therapy 12%, targeted therapy 8%, photodynamic therapy 1%, observation/supportive care 3%, hospice 9%. The median survival was 1.69 years [95% CI=1.34, 2.17, range 0.1-6.21]. For early stage cancer it was 2.02 years [95% CI=1.56, 2.87], and for advanced stage cancer, 1.06 years [95% CI=0.58, 1.63] (p=0.02 by log-rank). Treatment related mortality was low (1.1%). In conclusion, our nonagenarians underwent a broad range of treatments with low treatment related mortality. Advanced cancer still limits the survival of nonagenarians. Second cancers are frequent in older cancer survivors.