Malignant disease and the elderly

Most cancers are diseases of the ageing. Approximately 50% of all cancers occur among those over 65 and nearly 60% of all cancer deaths occur among the elderly. The cumulative risk of acquiring cancer among those aged 65-85 is 17% in females and 23% in males. Cancer incidence increases steadily as a function of age, reaching 23 per 1000 population among those aged 85 and older. Recent estimates of age-specific cancer prevalence rates for women over 70 were 106 per 1000 population and were 118 per 1000 population among men over 70. The rapidly shifting age distribution in most industrialized nations, including the growth of the 'old-old', means that the actual number of older people with cancer will increase at least in proportion to the ageing of the population. This trend will have an impact on the health-care system and may affect social norms regarding the treatment of elderly cancer patients. This paper reviews these trends and presents data from a series of research projects and the related literature to examine how older people respond to cancer symptoms and treatment and whether the treatment received by aged cancer patients differs from that given to younger patients. The relationship between age and stage of disease at presentation is explored, together with the manner in which older cancer patients' disease is identified, the 'aggressiveness' of treatment pursued, and patients' responses to those treatments.