Health Care System Must Prepare to Treat Growing Population of Older Cancer Survivors, Study Says

The number of older citizens within the United States is quickly growing, and the effect of that phenomenon on the health care system is referred to by many as a “silver tsunami.”
BY Ellie Leick
PUBLISHED July 01, 2016
The number of older citizens within the United States is quickly growing, and the effect of that phenomenon on the health care system is referred to by many as a “silver tsunami.” As a result of this trend, the number of cancer survivors living into old age is expected to dramatically increase, according to a study just published in Cancer Epidemiology, Biomarkers & Prevention.

In response to the rise in the number of older patients who have cancer or have survived the disease, the study’s authors suggested, it is important that medical professionals prepare for the health needs of this group, which will likely be complex due to other health problems associated with advancing age.

“Although a number of interventions have been developed to help survivors cope with cancer and thrive in the face of cancer-related symptoms, few have targeted older adults, and this remains an area of critical need in survivorship science,” lead author Shirley Bluethmann and her colleagues wrote in their paper. “Importantly, effective strategies must be implemented now to address the tsunami of aging cancer survivors that is rapidly approaching.”

The authors project that the overall number of cancer survivors in America will rise from 15.5 million to 26.1 million between this year and 2040; while 62 percent of today’s cancer survivors are age 65 years or older, by 2040, 73 percent of cancer survivors will fall into that age group. Among that 73 percent, 24 percent will be ages 65 to 74 years, 31 percent will be ages 75 to 84 years and 18 percent will be 85 years or older.

A further clue about where the health needs of this group will lie is that there are more older men than women who have survived cancer, especially in the population of people over age 90 years. Within that group, 37 percent of men and 25 percent of women are survivors of cancer. This stark difference in numbers is likely due to prostate cancer, which is generally found in older men, the authors reported.

Looking at comorbidities, the study team found that, over the past decade or so, the likelihood of these additional health problems was much more associated with advancing age than with a patient’s cancer history. Of people who’d never had cancer and were age 85 years or older, 42 percent had serious comorbidities, while 47 percent of cancer survivors in that age group had a similar burden of comorbidities. Among people not affected by cancer who were 66 to 74 years of age, 66 percent had no comorbidities, compared with 56 percent of cancer survivors in that age group.

Among older cancer survivors, those who had experienced lung cancer had the worst burden of comorbidities, and those who’d had breast or prostate cancers had the lightest burden. The most common comorbidities among older cancer survivors were congestive heart failure, chronic obstructive pulmonary disease and diabetes.

Due to the medical complexities associated with comorbidities, older adults with cancer often cannot participate in clinical trials. As a result, little is known about how to treat patients who develop cancer at older ages.

“Older patients have the same cancer treatment options as all patients and survivors have, but there are special considerations with older adults,” explained Bluethmann, a cancer prevention fellow at the National Cancer Institute. “Age is one of them, but we also know age doesn’t tell us all the information we need. We also have to look at their medical history, as well as their individual strength and functionality. An older person will work with the doctor and medical team to determine what they need in their individual situation, but one of the factors that needs to be taken into consideration is if they will be able to tolerate all types of treatment. Older people can be very sensitive to chemotherapy. How the dosing will affect the individual is hard to predict.”

Bluethmann recommended recruiting more older people into clinical trials, but in the meantime, the authors had suggestions for supportive care for this population. They suggested counseling about lifestyle, including physical activity, as a means of reducing symptoms related to cancer in older people. They noted that comorbidities that pre-exist cancer “are important predictors of function and health status in the posttreatment period, potentially offering an opportunity to focus on rehabilitation.” Finally, the authors recommended that vulnerable populations, such as lung cancer survivors, be identified and screened to see how they are functioning and what kinds of support they may need, as a way to help them survive long-term.

“We definitely need to be rethinking the care implications,” Bluethmann said. “Part of that is recruiting more older adults into clinical trials so we’ll have better information about the type of treatments they need, as well as the types of lifestyles and quality-of-life interventions they might benefit from. We also need to do a better job of engaging a broader health care team, such as other primary care doctors, nurses, caregivers and family members who may be providing care to the survivors as they’re facing recovery, as well as other health conditions.”

Incidence and survival data cited in the study spanned from 1975 through 2012 and were collected by the Surveillance, Epidemiology and End Results (SEER) program. SEER data, in addition to Medicare claims, were used to estimate the comorbidities commonly found in older adults. Further, researchers used data from the United States Census Bureau and applied the prevalence approach model to create their prediction of cancer prevalence in 2016 to 2040.
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