Cancer rates, medical comorbidities, and treatment modalities in the oldest patients

Zeber, John E.; Copeland, Laurel A.; Hosek, Brandon J.; Karnad, Anand B.; Lawrence, Valerie A.; Sanchez-Reilly, Sandra

doi:10.1016/j.critrevonc.2008.02.002

Cited by 49 publications

(29 citation statements)

References 30 publications

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“…Other studies have reported similar results as ours and also found a high prevalence of ulcer and CPD (Yancik et al , 1996; Gross et al , 2006; Smith et al , 2008), whereas some studies have not found any significant differences between elderly colorectal cancer patients and controls in the comorbidity burden (Driver et al , 2010). Comorbidity had a negative impact on overall but not on cancer-specific mortality which is in accordance with the findings of most other studies (Yancik et al , 1998; Janssen-Heijnen et al , 2005; Asmis et al , 2008; Zeber et al , 2008). However, Koukoran et al found that comorbidity was not associated with overall but with an increased cancer-specific mortality.…”

Section: Discussionsupporting

confidence: 91%

“…Several reports have shown a high prevalence of comorbid conditions among elderly cancer patients (Ogle et al , 2000; Koroukian et al , 2006; Wedding et al , 2007), but few studies have compared the prevalence of comorbidity in people with and without cancer. Furthermore, results have been conflicting; some studies have reported a clear association between a diagnosis of cancer and increased comorbidity (Smith et al , 2008), whereas others have not (Zeber et al , 2008; Driver et al , 2010). …”

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confidence: 99%

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Comorbidity in elderly cancer patients in relation to overall and cancer-specific mortality

et al. 2012

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Background:Aims of this study were to describe the prevalence of comorbidity in newly diagnosed elderly cancer cases compared with the background population and to describe its influence on overall and cancer mortality.Methods:Population-based study of all 70+ year-olds in a Danish province diagnosed with breast, lung, colorectal, prostate, or ovarian cancer from 1 January 1996 to 31 December 2006. Comorbidity was measured according to Charlson's comorbidity index (CCI). Prevalence of comorbidity in newly diagnosed cancer patients was compared with a control group by conditional logistic regression, and influence of comorbidity on mortality was analysed by Cox proportional hazards method.Results:A total of 6325 incident cancer cases were identified. Elderly lung and colorectal cancer patients had significantly more comorbidity than the background population. Severe comorbidity was associated with higher overall mortality in the lung, colorectal, and prostate cancer patients, hazard ratios 1.51 (95% CI 1.24–1.83), 1.41 (95% CI 1.14–1.73), and 2.14 (95% CI 1.65–2.77), respectively. Comorbidity did not affect cancer-specific mortality in general.Conclusion:Colorectal and lung cancer was associated with increased comorbidity burden in the elderly compared with the background population. Comorbidity was associated with increased overall mortality in elderly cancer patients but not consistently with cancer-specific mortality.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Comorbidity in elderly cancer patients in relation to overall and cancer-specific mortality

et al. 2012

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“…This seems to result in strikingly low rates of treatment in veteran patients aged 85 and above. 2 Among patients with lung, head and neck, colorectal, and prostate cancer, only 0.6% underwent surgery; 0.7%, radiation therapy; and 0.8%, chemotherapy in 2005. In a population database, breast cancer patients above the age of 80 were often undertreated, with a negative impact on cancer-specific survival.…”

Section: Introductionmentioning

confidence: 99%

Cancer in nonagenarians: profile, treatments and outcomes

Extermann¹,

Crane²,

Boulware³

2010

Journal of Geriatric Oncology

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Objective: An increasing number of nonagenarians are treated for cancer. However, very few data are available to guide treatment choices in this often frail population. Materials and methods: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.Results: For 23.5% of patients, the index cancer was a second malignancy. Initial treatments were surgery, 41%; chemotherapy, 9%; radiation therapy, 15%; concomitant chemoradiation 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%).Conclusions: 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.

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“…More than half of all cancer patients age 50 to 74 years have at least one comorbidity, and this proportion rises to nearly two thirds in those age 75 and older [20]. As the age distribution of the population shifts, it is expected that there will be an increasing number of older patients with comorbidities who will be diagnosed with and treated for cancer [18] [21]. The presence of comorbidities adds complexity to cancer management because it may influence prognosis and treatment decisions and affect overall goals of care.…”

Section: Discussionmentioning

confidence: 99%