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The Interface of Aging and Cancer

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The risk of developing cancer increases with age. Because of this vulnerability for our Nation's aging population, NCI is conducting innovative research to better understand the relationships between aging and the development and progression of cancer. Further work is needed to fully address the interface of aging processes with cancer detection, diagnosis, and pre-treatment evaluation as well as the efficacy and tolerance of anti-cancer drugs in older patients.

By 2030, 20 percent of the U. S. population will be over 65 and the number age 85 years and older will have more than doubled in size from 4 million to approximately 8.5 million. Close to 58 percent of all newly diagnosed malignancies and 71 percent of all cancer deaths are in persons 65 and older according to the NCI Surveillance, Epidemiology, and End Results (SEER) program data for 1995-1999. As people live longer, more will experience cancer. As a result, there will be many more cancer survivors, many of whom will experience residual problems that impact their quality of life. Growing older as a cancer survivor also increases one's chances of developing other health problems, disabling conditions, and the recurrence of cancer.

Cancer statistics, demographic projections, and epidemiologic perspectives combine to illustrate the need to develop cancer control and cancer research strategies that address the magnitude of the cancer problem for current and future older Americans. NCI and the National Institute on Aging (NIA) have partnered to integrate crosscutting aging and cancer research priorities. The research includes the biology of aging and cancer, the impact of aging on cancer treatment, the quality of survivorship, symptom control, and disease-specific studies.

Biology of Aging and Cancer

Older patients differ from younger patients in susceptibility to disease progression and response to treatment. The underlying mechanisms of cancer and aging overlap in the study of tumor initiation, progression, and maintenance. Studies to better identify the molecular alterations in carcinogenesis related to the aging process intersect a number of NCI priority areas.

  • Genes and the Environment studies examine genetic changes, environmental influences, and host factors such as oxidant stress and cell death that may alter tumor progression in the aging patient.
  • Signatures of Cancer studies focus on the interaction of normal aging cells and cancer cells within the tumor microenvironment, differences in the manifestation of cancer types in older and younger patients, cellular and molecular characteristics that distinguish between those patients who could benefit from aggressive therapy and those who could be spared further therapy, and molecular alterations in carcinogenesis that are related to aging cells.
  • Cancer Imaging studies have led to an expanding array of diagnostic procedures such as the use of magnetic resonance probes, radiopharmaceuticals, and optical probes to reduce cancer treatment side effects and optimize recovery for older patients.
  • Quality of Cancer Care studies link the NCI SEER cancer registry to Medicare and other insurance data to assess the quality of cancer care and survivorship for older patients, early and late effects of treatment, occurrence of multiple primary tumors, and methodology for assessment and reporting.

Improving Cancer Outcomes, Survivorship, and Symptom Control for the Aging

We know that current healthcare practices frequently fall short of providing the best available early detection, treatment protocols, and quality care that older patients deserve. Studies show that older people are less likely to be screened for prevalent cancers such as breast, colorectal, and cervical disease. Older patients receive care for symptom control less frequently because of inadequate standards of care. For example, a 1998 study of cancer patients in nursing homes found that 26 percent of patients with daily pain received no analgesics. A number of NCI-supported studies focus on issues of cancer treatment and care for older people.

  • The National Clinical Trials Program works to increase the accrual of people 65 and older to early trials through NCI Cooperative Groups and develops trials that are specifically designed for older cancer patients. Trials for new agents and toxicology models include efficacy and tolerance evaluations in the aging.
  • Quality of Cancer Care studies focus on developing guidelines for treatment decisions that assess co-morbid conditions and the limited functional reserve of the older person. Researchers are investigating the effects of multiple health problems on early detection, diagnosis, prognosis, and treatment of older cancer patients. Other studies test the efficacy of current methods of symptom management in older patients using evidence-based guidelines.
  • Survivorship studies identify potential short- and long-term medical effects induced by treatment such as susceptibility of the older patient to multiple primary tumors, anti-tumor drug alterations, and cancer recurrence. Future research will focus on developing methods to prevent or offset these problems in older persons.
  • Molecular Targets of Prevention and Treatment studies examine the human biology of cancer and aging that reveal which aspects of tumor biology and tumor growth vary by age. These investigations have the potential to provide information that could lead to tailored therapeutic approaches.

Several recommendations for engaging NCI-supported Cancer Centers in pioneering research on issues faced by older cancer patients and their care givers came out of a June 2001 workshop jointly sponsored by NCI and NIA.

Studying the Impact of Colorectal Cancer on the Older Patient

Colorectal cancer is third in cancer incidence and mortality in the United States. SEER data for 1995-99 show that 70 percent of the incidence of colon and rectum tumors are in individuals 65 years and older. Yet, there is a paucity of attention to older persons affected by these cancers. A much-needed knowledge base would include:

  • Surveillance of persons at high risk
  • Influence of concomitant age-related problems
  • Gender and racial differences
  • Pathogenesis of colorectal cancer
  • Influence of coexisting diseases
  • Criteria for older surgical candidates
  • Modification of surgical procedures in older patients
  • Preoperative assessment to assist surgeons in prognosis and treatment

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