The United States—and much of the world—is experiencing unprecedented demographic shifts in the population of older people, defined as people age 65 and over. In 2012, the population of older people in the United States reached a never-before seen height of 43.1 million, a number that will more than double to a projected 83.7 million, by 2050.1
From an oncology perspective, the aging of the population is already acutely felt. After all, people age 65 and older account for 60% of cancer diagnoses, 69% of cancer deaths, and more than 60% of all survivors.2 Combine these cancer statistics with the reality of a rapidly growing aging population, and it is easy to see how the field of geriatric oncology will become a defining concern for oncologists worldwide over the next few decades.
Needs of the Older Patient With Cancer
In some ways, older patients with cancer have an advantage over younger patients, with studies showing that older age bestows upon patients a greater ability to face the psychological challenges that attend a cancer diagnosis.3
In other ways, however, older patients are at a disadvantage: As age goes up, so does the risk of developing toxicity as a result of treatment. Older patients are also more likely to develop numerous toxicities, including febrile neutropenia, anemia, osteoporosis, depression, and fatigue—conditions that interact with, and are complicated by, the presence of age-related diseases, such as diabetes and cardiac disease.
Treating older patients is also complicated by the fact that as people grow older, chronologic age is no longer a reliable indicator of overall health, said Arti Hurria, MD, leader in the field of geriatric oncology and medical oncologist and Director of the Cancer and Aging Research Program at City of Hope National Medical Center.
“At 40, we’re probably physiologically very similar, but as we age, there’s a lot more heterogeneity — the number 70 or 80 can no longer really reflect what that individual’s physiologic reserve is,” said Dr. Hurria, who is also the Past President of the International Society of Geriatric Oncology (SIOG) and Founder and Current Director of the Cancer and Aging Research Group (CARG).
In addition, older patients’ goals for treatment may differ from those of patients in an earlier stage of life. For example, when deciding on a treatment plan, an older patient might place much more weight on how a specific drug is likely to affect his or her independence and/or cognitive function than on whether it can bring about cure or remission.4
Integrating Geriatric Oncology Into ASCO Programs
Caring for older patients with cancer demands that clinicians acquire a strong knowledge base and skill set in geriatric oncology. But often, the multiple demands on early-career oncologists’ time means this kind of in-depth geriatric knowledge is not provided.
In order to address this educational gap, ASCO has placed geriatric oncology at the front and center of its efforts, launching initiatives such as the Journal of Clinical Oncology (JCO) “Special Series on Geriatric Oncology;” spearheading educational efforts to integrate geriatric oncology into general sessions at the Annual Meeting and into ASCO University® modules; addressing the oncology workforce shortage; bringing awareness to research needs in geriatric oncology; and introducing early-career oncologists to research on aging through the Leadership Development Program and the Conquer Cancer Foundation of ASCO’s Young Investigator Award (YIA) and Career Development Award (CDA).
Addressing a Gap in the Research
ASCO leadership and volunteers are working to address one of the main challenges facing geriatric oncology: Older people with cancer are not enrolled onto studies in proportion to their numbers, resulting in a lack of evidence to help guide treatment decisions in the geriatric population.
A 2004 study in JCO reported that while older patients comprise 60% of patients with cancer in the United States, they represent only 36% of patients enrolled onto trials. This discrepancy between the actual number of older patients with cancer and their representation on trials only increases with age.5
Earlier this year, ASCO issued a position statement, “Improving the Evidence Base for Treating Older Adults with Cancer,” calling for federal agencies and the cancer research community to broaden clinical trials to include older adults. The position statement makes the five following overarching recommendations:
- Use clinical trials to improve the evidence base for treating older adults.
- Leverage research designs and infrastructure to improve the evidence base for treating older adults.
- Increase U.S. Food and Drug Administration (FDA) authority to incentivize and require research on older adults with cancer.
- Increase clinicians’ recruitment of older adults with cancer into clinical trials.
- Utilize journal policies to incentivize researchers to consistently report on the age distribution and health risk profiles of research participants.
Through its efforts to integrate geriatric oncology learning into all of its educational endeavors and improve the evidence base for treating older adults with cancer, ASCO is working to fulfill its vision—that “all patients with cancer will have lifelong access to high-quality, effective, affordable, and compassionate care.” ■
Selected portions reprinted from ASCO Connection. © American Society of Clinical Oncology. “Focus on Geriatric Oncology: ASCO Prepares for an Aging Nation.” ASCO Connection, December 2014. All rights reserved.
References
1. United States Census Bureau: An aging nation: The older population in the United States: Population estimates and projections.www.census.gov/prod/2014pubs/p25-1140.pdf. Accessed Oct 5, 2014.
2. Hurria A: Improving the evidence-base for treating older adults with cancer. [PowerPoint]. Alexandria, VA: Cancer Research Committee Meeting; September 30, 2014.
3. Rowland JH, Bellizzi KM: Cancer survivorship issues: Life after treatment and implications for an aging population. J Clin Oncol 32:2662-2668, 2014.
4. Hurria A, Dale W, Mooney M, et al: Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 32:2587-2594, 2014.
5. Talarico L, Chen G, Pazdur R: Enrollment of elderly patients in clinical trials for cancer drug registration: A 7-year experience by the US Food and Drug Administration. J Clin Oncol 22:4626-4631, 2004.
