Cancer in the Elderly: Clinical and Biologic Considerations

Abstract

Cancer is a disease of the elderly in that most cancers occur in persons over age 65. Cancer increases in incidence with age, however, not all cancers have that characteristic and some cancers decline in incidence in the very aged (over 80). Most physicians who treat patients with cancer tend to offer the elderly patient fewer options for therapy. There is a feeling that the older patient is less able to tolerate the stresses of adjunctive therapy, whereas the treatment in the elderly is as likely to involve surgery. There is no evidence that elderly patients have more aggressive disease that result in shorter survivals. A careful study of the toxicity of chemotherapy drugs in patients over 70 failed to reveal a generalized increase in severe drug side effects. Certain drugs were associated with increased toxicity but these are resultant to the known physiologic changes that occur in the elderly, namely, decreases in renal clearance and renal blood flow. Finally, the theory that cancer in the elderly is associated with loss of immune competence and therefore fosters a more aggressive disease cannot be substantiated. It is postulated that the measures of early detection and prevention are just as applicable to the elderly as they are to the younger patient.

Supported by grants: CA21076, CA23318, CN75348 and CA36591