Cancer is more common in older Australians, with 68% of cancers diagnosed in 2010 detected among people aged 60 years or older. Cancer treatment in older people is complicated by a number of factors. The decision to treat elderly patients is not only based on the type and stage of the cancer, but also on the patient’s physical and mental ability to tolerate treatment. Older patients often have other illnesses and are taking multiple medications. Co-occurring or co-morbid diseases and functional impairment are associated with poorer cancer prognosis. The opportunity to manage older patients’ other health problems in advance of their cancer treatment may increase its benefits by ensuring they are as fit as possible before undertaking their treatment.
For all patients the decision to have treatment is a balance between the potential benefits and adverse effects. Older patients may have different perspectives to younger patients. For example, older patients may consider short-term quality of life and the ability to continue to manage their day-to-day activities more important than a modest survival advantage. Alternatively, some fit older patients may see aggressive treatment as worthwhile if they can expect a similar outcome as younger patients. Older cancer patients should be offered treatment options based on their state of health and fitness rather than their chronological age.
Older cancer patients are also underrepresented on clinical trials of cancer treatments, as most studies have inclusion criteria which prevent people with other illnesses and/or taking other medications from participating. Therefore there is less evidence to show that certain treatments are effective among this population. The research that has been conducted on elderly cancer patients and their responses to cancer treatment indicates that treatment is appropriate for non-frail elderly patients. There is however a need for more research on the effectiveness of cancer treatments among the elderly cancer patient population.