A wide difference in cancer survival between middle aged and elderly patients in Europe

Abstract

Nowadays the burden of cancer in elderly people has reached an alarming extent. The purpose of this study is comparing cumulative and conditional relative survival in elderly patients between 65 and 84 years and younger adults aged from 55 to 64. Fifty-three cancer registries of 22 European countries, participating in the EUROCARE-3 programme, collected information on the cases diagnosed over the period [1990][1991][1992][1993][1994]. We computed cumulative and conditional relative survival for 16 cancer sites. Middle aged patients experienced a better prognosis than the elderly for all cancer sites, in both sexes and the differences were more marked at 1 than 5 years since diagnosis. The very large differences noted in the first period after cancer detection declined in the subsequent years and, when 5-years conditional survival was considered, for several cancers the elderly and younger adults had the same probabilities of surviving. The death relative excess risks (RERs) in the elderly with respect younger individuals were really very high and markedly larger at 1 than 5 years, and in women than men. Genitourinary and gynaecological cancers showed the highest RERs, around 2.0 and between 1.5 and 2.5 respectively. This very high early mortality could be due not only to clinical aspects: the barriers to health care access and a consequent late diagnosis might represent for elderly patients the main determinant of this very large prognostic disadvantage. In conclusion, clinical management of cancer in the elderly remains a major issue to be faced with complex social and health care policies. ' 2007 Wiley-Liss, Inc.Key words: cancer; conditional and cumulative relative survival; health care inequalities; elderly Western populations are rapidly ageing; this phenomenon has accelerated at least since the early 80 s. Now the magnitude of this issue has reached an alarming extent and the burden of chronic diseases like cancer requires an extraordinary effort by health care systems and social services.According to data by the United Nations, in 2000 the elderly over 65 years amounted in Northern, Western and Southern Europe to about 13-14% and 18-19% of all resident population in men and in women respectively. The phenomenon will reach a peak when the people born during the period of the ''baby boom'', in the 50-60 s, will be 65 years old. For instance, in Italy, the country with the highest proportion of people aged 65 years or over (15% in men and 21% in women), by 2030 this population segment will represent 29% and 35% of total population. In this demographic context the cancer burden is quickly increasing; on one hand incidence and mortality trends of some major cancers are levelling off or declining, on the other hand crude rates are growing as a consequence of people ageing. If we consider the single European macro-regions in 2002, we observe very variant situations: in Eastern countries only 49% in men and 48% in women of all cancers were detected in the elderly, the corresponding values increased to 67% and 58%...

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