Cancer Treatment Rates Low among Elderly Veterans
Cancer disproportionately affects our older population, with an 11-fold higher incidence of cancer in people over the age of 65 relative to their younger counterparts. Age is the single most important risk factor for developing cancer, yet toxicity concerns may lead to under-treatment of cancer in the elderly. This study examined elderly veterans diagnosed with lung, colorectal, prostate, or head and neck cancer in 2005 (n=194,797), comparing treatment by age group – 70 to 84 (younger elders) vs. 85 to 115 (older elders). Findings show that although the number of cancer diagnoses among veterans was high, treatment rates appeared low, particularly for the older elders. Treatment was more common among younger elders, including: surgery (1.3% vs. 0.6%), chemotherapy (2.1% vs. 0.8%), and radiation (1.7% vs. 0.7%). Differences were sharper for certain cancers; for example, chemotherapy for lung cancer (9.0% vs. 2.9%) and colorectal surgery (5.8% vs. 3.4%). Overall, the predominant diagnosis was prostate cancer (77%), followed by colorectal (13%), lung (10%), and head and neck cancer (3%).
Chemotherapy and radiation toxicities are a significant concern in the elderly; however, the authors suggest that it is possible that an exaggerated level of trepidation regarding these treatment ramifications may be an obstacle to appropriate treatment in patients who could benefit from it.
Zeber J, Copeland L, Hosek B, Karnad A, Lawrence V, and Sanchez-Reilly S. Cancer rates, medical comorbidities, and treatment modalities in the oldest patients. Critical Reviews in Oncology/Hematology September 2008;67(3):237-42.
This study was funded through VA, including support through HSR&D’s VERDICT (Veterans Evidence-Based Research Dissemination and Implementation Center) and through Dr. Copeland’s HSR&D Career Development Award. Drs. Zeber, Copeland, Lawrence, and Mr. Hosek are all part of VERDICT.