Education And Debate

Cancer in old age—is it inadequately investigated and treated?

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7205.309 (Published 31 July 1999) Cite this as: BMJ 1999;319:309
  1. N J Turner, specialist registrar (nicola_turner@talk21.com)a,
  2. R A Haward, professorb,
  3. G P Mulley, professora,
  4. P J Selby, professorc
  1. a Department of Medicine for the Elderly, St James's University Hospital, Leeds LS9 7TF
  2. b Research School of Medicine Centre for Cancer Research, Yorkshire Cancer Organisation, Cookridge Hospital, Leeds LS16 6QB
  3. c Research School of Medicine Centre for Cancer Research, ICRF Cancer Medicine Research Unit, St James's University Hospital, Leeds LS9 7TF
  1. Correspondence to: N J Turner
  • Accepted 6 April 1999

The proportion of the United Kingdom population over 75 years of age will increase from around 7% to nearly 11% in the next 50 years, with a disproportionate rise in those over 85 years. There will be a large increase in the number of elderly patients with cancer Already over one third of cancers are diagnosed in people over 75, yet we do not know how best to investigate and treat cancers in these patients. Many clinical trials have used arbitrary upper age limits. Even trials in allegedly elderly subjects start at age 65. Very few studies include large numbers of old (over 75) or very old (over 85) people.1 The role and effectiveness of many cancer treatments is therefore not evidence based in those most affected.

Studies of cancer care in elderly patients show fewer diagnostic and staging procedures and less treatment with advancing age. Disease specific survival rates decline with age.26 This is illustrated by data from the Yorkshire Cancer Registry on histological confirmation (a useful marker for the adequacy of investigation), receipt of definitive treatment, and relative survival in relation to age group (table).7 The Yorkshire Cancer Registry is one of the registries used in the Eurocare study. It covers a population of 3.7 million, constituting 7.2% of the total population of England and Wales.

View this table:

Proportion (%) of cancers confirmed by histology, cancer patients with no definitive treatment, and cancer patients surviving five years, by age group, Yorkshire 1989-93

Summary points

Although more than a third of cancers are diagnosed in people over 75, this group is less extensively investigated and receives less treatment than younger patients

75 year old women and 75 year old men have life expectancies of 11.1 years and 8.5 years respectively

Reduced levels of intervention are not wholly explained …

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