People 65 years old or more are the fastest growing segment of the population in the United States . By 2030, this group will comprise about 20 percent of the total population, and among elderly persons, the percentage of patients >75 and >85 years old will increase disproportionately. A similar aging of the population is present in Western Europe and Japan.
The importance of this demographic increase in the number of elderly persons is magnified by the sharp rise in the incidence of most types of cancer after age 60 years. Currently approximately 50 percent of all cancers and 70 percent of cancer deaths occur in those ≥65 years old, and this fraction is expected to increase [1-3].
Despite the frequency with which cancer occurs in the elderly population, this group is significantly underrepresented in clinical trials [4-6]. Elderly patients who are enrolled in clinical trials represent a carefully selected subset. A systematic review of 345 cooperative group trials found no evidence of poorer survival or increased treatment-related mortality with experimental treatments compared to younger patients, despite concerns about an increased risk of toxicity .
Even when substantial numbers of older patients are included, the results cannot be extrapolated to the entire elderly population. Patients with a poor performance status or renal, hepatic, or bone marrow dysfunction generally have been excluded, thus raising questions about the general applicability of data derived from such trials. This is particularly true for patients over 80 years.
Challenges specific to older patients with advanced cancer and the treatment of common malignancies in the elderly population will be reviewed here. Detailed discussions of the therapy of specific malignancies are presented separately, and additional information on specific chemotherapy drugs can be found in the UpToDate drug database.