Cancer in the Elderly PDF

Preface

Cancer is a disease of genetic alterations in DNA that may result from an inherited predisposition, altered host susceptibility, or an interaction between environmental factors and an individual's inherent profile of genetic susceptibility. Cancer risk increases with age, as complex molecular and biological changes occur. The greatest burden of cancer occurs in men and women aged 65 years and older, a population that suffers excess morbidity, reduced quality of life, and economic disparity due to chronic disease. Advancements in the diagnosis and treatment of cancer have been associated with modest reductions in morbidity and improved quality of life. Yet the challenges of cancer in an aging population remain.

For the better part of the twentieth century, cancer in the elderly received little attention. Screening and early detection were generally not offered to older patients. Despite the demonstrated benefit from detecting early disease in screening trials, older women were (and still are) less likely than younger women to receive screening mammography and Papanicolaou tests. More advanced disease, less aggressive surgery, fewer treatment options and interventions, and a prevailing attitude among health care professionals to offer—and among patients to accept—more conservative approaches to diagnosis and treatment characterized cancer care in elderly patients.

The aging process is better understood now than it was in the past. Shifting demographics and improved health among the persons past middle age have led to a gradual transition from palliative or conservative disease management to an emphasis on disease prevention and expanded treatment options. New attention and research support have been directed toward the problem of cancer in the older populations by federal agencies, academic and private institutions, and other public health organizations. Older individuals have participated in clinical trials, and a critical mass of information has been accumulated. This book brings together a compendium of knowledge of cancer in the elderly, and we believe it will be useful for health care professionals, researchers, educators, policy makers, and students of public health and preventive medicine.

Cancer in the Elderly is divided into six parts. Part I begins with an epidemiological review of cancer in the elderly population of the United States, then looks at U.S. multiracial/cultural cancer patterns and the global burden of cancer in the elderly. It provides new insights into trends in cancer incidence and mortality, and examines the nature and extent of cancer burden in older populations. Part II examines medical evidence that secondary and primary control of cancer can be achieved in the elderly. This part also addresses screening and prevention of breast, prostate, and colorectal cancers and discusses the cultural attitudes, social structures, and the variety of constraints imposed by the health care system that affect how our society approaches the challenges of controlling cancer. Part III contains chapters on biological markers and the inherited susceptibility to cancer.

Part IV provides in-depth reviews of site-specific cancer treatments and the results of research interventions, including discussions on breast, gastrointestinal, gynecological, genitourinary, and lung cancer, as well as melanomas, sarcomas, and the major hematological malignancies. Special considerations in surgery, chemotherapy, and radiation treatment are presented. Part IV also examines the comparability of cancer patient populations in international studies with respect to transferability of results. Multidisciplinary interaction between oncologists and geriatricians is important in caring for elderly cancer patients, and the domain of geriatric oncology is emerging. Part V addresses several aspects of the decision making process, including co-morbidity, quality of life, health service research, management of the terminally ill, and methodological and assessment issues unique to elderly patients. Part VI highlights selected health policy issues concerning cancer in the elderly that will be increasingly important in the new millennium.