Oldest of Old Americans Will Drastically Impact U.S. Cancer Care

The numbers are stark and will touch every single American.

A picture of cancer in the greying American population was drawn in a recent study in the Journal of Geriatric Oncology examining trends in the National Cancer Institute’s population-based SEER data:

The number of “oldest of the old” Americans (age 85 or older) will double between 2000 and 2030; and will have tripled by 2040 (from 4.3 million to 15.4 million).

  • Cancer in the oldest old is the 2nd leading cause of death: More than 1 in 5 over age 85 will develop cancer.
  • The total cost of cancer care will rise 39% in just 10 years, between 2010 and 2020—much of that cost in care for elderly.
  • Among those age 85 or above, colorectal cancer (CRC) is the most common cancer.

That’s some of the bad news. But the recent story of colorectal cancer, ironically, also brings a ray of hope.

Colorectal cancer trends among both the general population and among the elderly might provide a trailmarker for one path to control both cancer cases and costs in the future grey America:

  • The overall incidence (frequency of occurrence) in the oldest old—as in all ages—is actually dropping, largely due to major decrease in colorectal cancer (36% since 1985).
  • The dropping rate of CRC comes directly from more screening (increased from 35% to 56% of the general population in the past 20 years), which was prodded along by adding Medicare screening coverage in 1998.   

For this cancer, at least, screening and prevention has and will be the fastest way to save dollars. (Education and prevention will also be key for what the authors predict will be the most common cancers in the elderly by 2030—lung cancer and especially invasive melanoma, which may triple in the next 20 years.)

Where are the elderly in clinical trials?

“Just as ‘children are not small adults,’ seniors are not just older adults,” caution the authors. Yet the elderly are seriously missing in clinical trials of new cancer treatments: An FDA study found that only 9% of patients in cancer drug trials were aged 75 or more, even though very few trials set an upper limit for eligibility.

Yet evidence from labs, clinics and expert consensus suggest that cancer in the elderly shows different tumor biology, the patient’s response to both the cancer and treatment, and vulnerability to treatment side effects.

Beyond better cancer research for the elderly, the authors urged, the U.S. needs to train practitioners: Of 154 adult oncology/hematology fellowship programs, only 10 have geriatric onology programs—and several of those “are in jeopardy of closing due to lack of institutional support or funding.”

 Source: Journal of Geriatric Oncology 3 (2012), p. 299-306

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