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Silver survivors: how do we know if people are ‘too old’ for cancer treatment?


Cancer is primarily a disease of older age. Six in ten new cases each year in the UK occur in those aged 65 years or over [1], and 13% of the total UK population aged 65 years or over have been diagnosed with cancer at some point in their lives [2]. However, while cancer mortality rates fell by 16–17% between 1995 and 2005 for under 75-year age group, they reduced by only 6% in the 75–84-year age group and actually rose in the over 85-year age group [3]. Relative survival also decreases with increasing age at diagnosis for the majority of cancers. The average relative 5-year survival in England for the top four most commonly diagnosed cancers in the UK (breast, lung, prostate and bowel) decreases from 64% among those aged 60–69 years at diagnosis to 57% among those aged 70–79 years, and 42% among those aged 80–99 years [4]. Furthermore, relative 5-year survival among those aged 65 years or over is 14% lower in the UK compared with the European average [5].

There are many factors that contribute to these poorer outcomes. Later presentation is a recognized problem [6]. Older patients may be less aware of some cancer symptoms [7], wait longer before reporting them and may not know that age increases the risk of cancer. For example, in one study, 75% of women aged 67–73 years did not know that the risk of cancer increases with age [8]. Older people with cancer also have an average of three other morbidities [9], which both mask symptoms of cancer and complicate treatment. Nevertheless, at least part of the reason for poorer outcomes is related to the types of treatment older people with cancer in the UK do, or do not, receive.

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