Increasing Numbers of Older Cancer Survivors Challenge Clinical Trial Participant Criteria
Larger numbers of older cancer patients are becoming survivors due to improved cancer detection and treatment efforts, combined with demographic trends. The increasing numbers of older cancer survivors are likely to have other health conditions that impact care and well-being.1
"Understanding the impact of a graying nation on cancer prevalence is critical in informing efforts to design and implement quality cancer care for this population," said Shirley M. Bluethmann, PhD, MPH, a cancer prevention fellow at the National Cancer Institute, Bethesda, Maryland, and lead author.
This study examined incidence and survival data from 1975 to 2011 from the Surveillance, Epidemiology, and End Results (SEER) Program, and the researchers projected US cancer prevalence from 2016 to 2040. They linked SEER data with Medicare claims to estimate comorbidities that are commonly experienced in older adults, including health conditions such as heart disease, lung disease, or diabetes.
Currently, an estimated 15.5 million cancer survivors are living in the United States, and 62% of that group is age 65 years or older. The study projects that, by 2040, there will be 26.1 million cancer survivors, and 73% of them will be 65 years or older.
The oldest age groups will come to represent a larger proportion of the population of cancer survivors. In 2040, survivors age 65 to 74 years will account for 24% of all survivors, those 75 to 84 years will account for 31% of all survivors, and those 85 years and older will represent 18% of all survivors. Compared with the prevalence estimates for 1975, the projected prevalence estimates in 2040 show a 6-fold increase for those 65 to 74 years, a 10-fold increase for those 75 to 84 years, and a 17-fold increase for those 85 years and older.
Chances are higher that survivors of increasing age will have 1 or more comorbid conditions. Among cancer survivors age 65 to 69 years, 27% had a history of severe comorbidity. Among cancer survivors 85 and older, 47% had severe comorbid conditions.
Bluethmann explained that older adults are underrepresented in clinical trials, as their comorbid conditions may make them ineligible. This lack of study of older adults presents challenges in delivering effective and age-appropriate cancer care.
"Because of this, we lack key data which would inform how geriatric populations would react to or benefit from precise cancer treatments or interventions," she explained. Bluethmann's study adds to evidence that shows older adults often have complex health needs that must be addressed in efforts to deliver high-quality health care.
"We have known about the potential impact of the maturing baby boom generation for some time, but this study provides compelling, specific evidence of the impact of cancer on older Americans, now and in the future," Bluethmann said. "The changing demographics of this country are unmistakable, and it's time to rethink our approach to aging and cancer."
1. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiology, Biomarkers & Prevention. 2016;25:1029-1036.