I first became aware of the aging and cancer connection in the early 1980s. It was in my early years as an Oncology Clinical Nurse Specialist that I distinctly remember being struck by the advanced ages of the patients on our oncology unit during rounds. Living in the Sun Belt region, I immediately assumed it was because of my geographic location that this was the case. Yet, I went to the literature to find out more about this phenomenon and was surprised with what I found.
I came upon a book published in 1983 that resulted from a working conference sponsored by the National Cancer Institute and the National Institute on Aging.1 Entitled, Perspectives on Prevention and Treatment of Cancer in the Elderly, the book ultimately became the impetus for my career-long endeavor to champion the needs of the elderly with cancer.
Chapters addressed statistics on the increasing incidence of cancer with age, pathophysiological considerations, treatment implications, the need for early detection, and a review of individual cancers and their predominance in the elderly. But most important to me, was the revelation that cancer in the elderly was not an entity unique to those areas where retirement prevailed. Rather it was a national phenomenon with practice implications for the entire community of cancer specialists across the United States.
Three decades have passed since my inaugural recognition of the cancer and aging paradigm. Since then, I have written more than fifty publications on cancer and aging (including chairing the Oncology Nursing Society’s two position papers on the phenomenon), and have given more than 100 lectures nationally and internationally on this topic. I am saddened to say, that as of 2016, there are only a handful of cancer programs nationally that have addressed this reality.
Whether it be due to ageism or ignorance, the facts must be faced. Consider the following:
Sixty-five percent of all cancer is diagnosed in the elderly, who represent only 13% of the United States population;
We are in the midst of an exponential increase in cancer driven by our aging population;
Due to the historic exclusion of the elderly from clinical trials and the paucity of contemporary elder-specific clinical trials, we currently treat older Americans using therapy outcomes performed on populations younger than those who have the disease.2-5
A historical roadmap of advocacy for populations under-represented in medical research reveals laws passed to enhance research of children, women, and minorities. Hurria and Levit then make a contemporary plea for advocacy as it relates to the elderly with cancer:6
Do we need a law that requires recruitment of study participants who mirror the age distribution of the disease?
Should we mandate pharma to investigate novel therapeutics in older adults most likely to receive the therapy?
My patience is wearing thin. It is timely to take on this regulatory agenda. Despite years of informational tactics to engage constituents to endorse this reality, the message has not been received and action has not occurred. Of note is a statement from Yancik’s historical work published 3 decades ago. In the concluding statement of the working conference, the following is shared:1
Older Americans deserve a cancer research agenda which includes them as a specific focus along the continuum of efforts in prevention, early detection, diagnosis, treatment, rehabilitation, and continuing care (p.331).
We as a collective body of cancer specialists must ask ourselves: Why the blindness? Why the omission? When the response?
Yancik R (Ed.). Perspectives on Prevention and Treatment of Cancer in the Elderly. Raven Press: New York. 1983.
Yancik R. Cancer burden in the aged: An epidemiologic and demographic overview. Cancer, 1997 Oct 1;80(7):1273-83.
Edwards BK, Howe HL, Ries LA, et.al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden. Cancer, 2002 May 15;94(10):2766-92.
Lichtman SM, Balducci L, Aapro M. Geriatric oncology; A field coming of age. Journal Clinical Oncology, 2007 May 10;25(14):1821-3.
Hurria A, Naylor M, Cohen H. Improving the quality of cancer care in an aging population: recommendations from an IOM report. JAMA, 2013 Nov 6;310(17):1795-6.
Hurria A, Levit L. Advocating for Older Adults With Cancer: Merging Medicine and Law. Journal National Comprehensive Cancer Network, 13(8): 940-941.
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