Aging and Cancer: What Oncologists Need to Know

  • Arti Hurria
  • Lodovico Balducci

Cancer is a disease associated with aging. Approximately 60% of cancer diagnoses and 70% of cancer mortalities occur in patients age 65 or older. By 2011 in the United States, the “Baby Boomer” generation will be turning 65. The aging of these baby boomers, along with a rise in the overall life expectancy, is leading to a rapid growth of the older U.S. population. By 2030, one in five Americans will be age 65 or older. These demographics, along with the known association between cancer and aging, will contribute to an enormous rise in the number of older adults with cancer. Incorporating geriatric principles of care will be increasingly essential to cancer treatment.


Social Support Cancer Survivor Breast Cancer Survivor Baby Boomer Treatment Tolerance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 2000;92(7):550–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Anders CK, Hsu DS, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 2008;26 (20):3324–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Estey E. Acute myeloid leukemia and myelodysplastic syndromes in older patients. J Clin Oncol 2007;25 (14):1908–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Jr., Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999;341 (27):2061–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Yee KW, Pater JL, Pho L, Zee B, Siu LL. Enrollment of older patients in cancer treatment trials in Canada: Why is age a barrier? J Clin Oncol 2003;21 (8):1618–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA. Representation of older patients in cancer treatment trials. Cancer 1994;74 (7 Suppl):2208–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Muss HB, Berry DA, Cirrincione C, et al. Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: The Cancer and Leukemia Group B Experience. J Clin Oncol 2007;25 (24):3699–704.PubMedCrossRefGoogle Scholar
  8. 8.
    Sawhney R, Sehl M, Naeim A. Physiologic aspects of aging: Impact on cancer management and decision making, part I. Cancer J 2005;11 (6):449–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Sehl M, Sawhney R, Naeim A. Physiologic aspects of aging: Impact on cancer management and decision making, part II. Cancer J 2005;11 (6):461–73.PubMedCrossRefGoogle Scholar
  10. 10.
    Vestal RE. Aging and pharmacology. Cancer 1997;80 (7):1302–10.PubMedCrossRefGoogle Scholar
  11. 11.
    Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985;33 (4):278–85.PubMedGoogle Scholar
  12. 12.
    Fehrman-Ekholm I, Skeppholm L. Renal function in the elderly (>70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance. Scand J Urol Nephrol 2004;38 (1):73–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Avorn J, Gurwitz, JH. Geriatric Medicine. Springer-Verlag, New York. 1997.Google Scholar
  14. 14.
    Baker SD, van Schaik RH, Rivory LP, et al. Factors affecting cytochrome P-450 3A activity in cancer patients. Clin Cancer Res 2004;10 (24):8341–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Hunt CM, Westerkam WR, Stave GM. Effect of age and gender on the activity of human hepatic CYP3A. Biochem Pharmacol 1992;44 (2):275–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Schwartz JB. Race but not age affects erythromycin breath test results in older hypertensive men. J Clin Pharmacol 2001;41 (3):324–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Sotaniemi EA, Arranto AJ, Pelkonen O, Pasanen M. Age and cytochrome P450-linked drug metabolism in humans: An analysis of 226 subjects with equal histopathologic conditions. Clin Pharmacol Ther 1997;61 (3):331–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Yuen GJ. Altered pharmacokinetics in the elderly. Clin Geriatr Med 1990;6 (2):257–67.PubMedGoogle Scholar
  19. 19.
    Baker SD, Grochow LB. Pharmacology of cancer chemotherapy in the older person. Clin Geriatr Med 1997;13 (1):169–83.PubMedGoogle Scholar
  20. 20.
    Lichtman SM, Hollis D, Miller AA, et al. Prospective evaluation of the relationship of patient age and paclitaxel clinical pharmacology: Cancer and Leukemia Group B (CALGB 9762). J Clin Oncol 2006;24 (12):1846–51.PubMedCrossRefGoogle Scholar
  21. 21.
    ten Tije AJ, Verweij J, Carducci MA, et al. Prospective evaluation of the pharmacokinetics and toxicity profile of docetaxel in the elderly. J Clin Oncol 2005;23 (6):1070–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Dees EC, O'Reilly S, Goodman SN, et al. A prospective pharmacologic evaluation of age-related toxicity of adjuvant chemotherapy in women with breast cancer. Cancer Invest 2000;18 (6):521–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Jen JF, Cutler DL, Pai SM, et al. Population pharmacokinetics of temozolomide in cancer patients. Pharm Res 2000;17 (10):1284–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Smith TJ, Khatcheressian J, Lyman GH, et al. Update of recommendations for the use of white blood cell growth factors: An evidence-based clinical practice guideline. J Clin Oncol 2006;24 (19):3187–205.PubMedCrossRefGoogle Scholar
  25. 25.
    Gomez H, Hidalgo M, Casanova L, et al. Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin's lymphoma: Results of a multivariate analysis. J Clin Oncol 1998;16 (6):2065–9.PubMedGoogle Scholar
  26. 26.
    Balducci L, Al-Halawani H, Charu V, et al. Elderly cancer patients receiving chemotherapy benefit from first-cycle pegfilgrastim. Oncologist 2007;12 (12):1416–24.PubMedCrossRefGoogle Scholar
  27. 27.
    Mancuso A, Migliorino M, De Santis S, Saponiero A, De Marinis F.Correlation between anemia and functional/cognitive capacity in elderly lung cancer patients treated with chemotherapy. Ann Oncol 2006;17 (1):146–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Rao AV, Cohen HJ. Fatigue in older cancer patients: Etiology, assessment, and treatment. Sem Oncol 2008;35 (6):633–42.CrossRefGoogle Scholar
  29. 29.
    Reuben DB, Rubenstein LV, Hirsch SH, Hays RD. Value of functional status as a predictor of mortality: Results of a prospective study. Am J Med 1992;93 (6):663–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients. J Am Med Assoc 1998;279 (15):1187–93.CrossRefGoogle Scholar
  31. 31.
    Stafford RS, Cyr PL. The impact of cancer on the physical function of the elderly and their utilization of health care. Cancer 1997;80 (10):1973–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Keating NL, Norredam M, Landrum MB, Huskamp HA, Meara E. Physical and mental health status of older long-term cancer survivors. J Am Geriatr Soc 2005;53 (12):2145–52.PubMedCrossRefGoogle Scholar
  33. 33.
    Audisio RA, Ramesh H, Longo WE, Zbar AP, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 2005;10 (4):262–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Maione P, Perrone F, Gallo C, et al. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: A prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 2005;23 (28):6865–72.PubMedCrossRefGoogle Scholar
  35. 35.
    Freyer G, Geay JF, Touzet S, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: A GINECO study. Ann Oncol 2005;16 (11):1795–800.PubMedCrossRefGoogle Scholar
  36. 36.
    Extermann M, Balducci L, Lyman GH. What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 2000;18 (8):1709–17.PubMedGoogle Scholar
  37. 37.
    Frasci G, Lorusso V, Panza N, et al. Gemcitabine plus vinorelbine versus vinorelbine alone in elderly patients with advanced non-small-cell lung cancer. J Clin Oncol 2000;18 (13):2529–36.PubMedGoogle Scholar
  38. 38.
    Firat S, Bousamra M, Gore E, Byhardt RW. Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002;52 (4):1047–57.PubMedCrossRefGoogle Scholar
  39. 39.
    Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL, Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. J Am Med Assoc 2004;291 (20):2441–7.CrossRefGoogle Scholar
  40. 40.
    Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994;120 (2):104–10.PubMedGoogle Scholar
  41. 41.
    Steyerberg EW, Neville BA, Koppert LB, et al. Surgical mortality in patients with esophageal cancer: Development and validation of a simple risk score. J Clin Oncol 2006;24 (26):4277–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Birim O, Kappetein AP, van Klaveren RJ, Bogers AJ. Prognostic factors in non-small cell lung cancer surgery. Eur J Surg Oncol 2006;32 (1):12–23.PubMedCrossRefGoogle Scholar
  43. 43.
    Meyerhardt JA, Catalano PJ, Haller DG, et al. Impact of diabetes mellitus on outcomes in patients with colon cancer. J Clin Oncol 2003;21 (3):433–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Hammarsten J, Hogstedt B. Hyperinsulinaemia: A prospective risk factor for lethal clinical prostate cancer. Eur J Cancer 2005;41 (18):2887–95.PubMedCrossRefGoogle Scholar
  45. 45.
    Goodwin PJ, Ennis M, Pritchard KI, et al. Fasting insulin and outcome in early-stage breast cancer: Results of a prospective cohort study. J Clin Oncol 2002;20 (1):42–51.PubMedCrossRefGoogle Scholar
  46. 46.
    Pavelka JC, Brown RS, Karlan BY, et al. Effect of obesity on survival in epithelial ovarian cancer. Cancer 2006;107 (7):1520–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Kaklamani VG, Wisinski KB, Sadim M, et al. Variants of the adiponectin (ADIPOQ) and adiponectin receptor 1 (ADIPOR1) genes and colorectal cancer risk. J Am Med Assoc 2008;300 (13):1523–31.CrossRefGoogle Scholar
  48. 48.
    Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults. J Am Med Assoc 2006;295 (7):801–8.CrossRefGoogle Scholar
  49. 49.
    Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47 (11):1245–51.PubMedCrossRefGoogle Scholar
  50. 50.
    Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. J Am Med Assoc 2001;285 (23):2987–94.CrossRefGoogle Scholar
  51. 51.
    Seeman TE, Berkman LF, Kohout F, Lacroix A, Glynn R, Blazer D. Intercommunity variations in the association between social ties and mortality in the elderly. A comparative analysis of three communities. Ann Epidemiol 1993;3 (4):325–35.PubMedCrossRefGoogle Scholar
  52. 52.
    Kornblith AB, Herndon JE, 2nd, Zuckerman E, et al. Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer 2001;91 (2):443–54.PubMedCrossRefGoogle Scholar
  53. 53.
    Kornblith AB, Herndon JE, 2nd, Weiss RB, et al. Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer 2003;98 (4):679–89.PubMedCrossRefGoogle Scholar
  54. 54.
    Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: Spouse caregivers. J Clin Oncol 2007;25 (30):4829–34.PubMedCrossRefGoogle Scholar
  55. 55.
    Rhee YS, Yun YH, Park S, et al. Depression in family caregivers of cancer patients: The feeling of burden as a predictor of depression. J Clin Oncol 2008;26 (36):5890-5.Google Scholar
  56. 56.
    Kua J. The prevalence of psychological and psychiatric sequelae of cancer in the elderly—How much do we know? Ann Acad Med Singapore 2005;34 (3):250–6.PubMedGoogle Scholar
  57. 57.
    Penninx BW, Guralnik JM, Ferrucci L, Simonsick EM, Deeg DJ, Wallace RB. Depressive symptoms and physical decline in community-dwelling older persons. J Am Med Assoc 1998;279 (21):1720–6.CrossRefGoogle Scholar
  58. 58.
    Langa KM, Valenstein MA, Fendrick AM, Kabeto MU, Vijan S. Extent and cost of informal caregiving for older Americans with symptoms of depression. Am J Psychiatry 2004;161 (5):857–63.PubMedCrossRefGoogle Scholar
  59. 59.
    Vinokur AD, Threatt BA, Vinokur-Kaplan D, Satariano WA. The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 1990;65 (5):1242–54.PubMedCrossRefGoogle Scholar
  60. 60.
    Miller M, Mogun H, Azrael D, Hempstead K, Solomon DH. Cancer and the risk of suicide in older Americans. J Clin Oncol 2008;26 (29):4720–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Wolfson C, Wolfson DB, Asgharian M, et al. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001;344 (15):1111–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Gupta SK, Lamont EB. Patterns of presentation, diagnosis, and treatment in older patients with colon cancer and comorbid dementia. J Am Geriatr Soc 2004;52 (10):1681–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Gorin SS, Heck JE, Albert S, Hershman D. Treatment for breast cancer in patients with Alzheimer's disease. J Am Geriatr Soc 2005;53 (11):1897–904.PubMedCrossRefGoogle Scholar
  64. 64.
    Hurria A, Goldfarb S, Rosen C, et al. Effect of adjuvant breast cancer chemotherapy on cognitive function from the older patient's perspective. Breast Cancer Res Treat 2006;98 (3):343–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Fried TR, Bradley EH, Towle VR, Allore H. Understanding the treatment preferences of seriously ill patients. N Engl J Med 2002;346 (14):1061–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.City of Hope National Medical CenterDuarteUSA
  2. 2.H. Lee Moffitt Cancer Center and Research InstituteTampaUSA

Personalised recommendations