Aging and Cancer Control

Any decision related to cancer prevention and treatment in older individuals is predicated upon the following questions.

1. Is the patient going to die of cancer or with cancer?

2. Is the cancer going to affect the patient's welfare during the patient's lifetime?

3. Is the patient able to tolerate the treatment?

The answer to these questions implies the estimate of the patient's life expectancy and functional reserve, of the aggressiveness of the tumor, and of the availability of effective treatment.

Currently, the estimate of life expectancy and functional reserve is based mainly on clinical data, provided by some forms of geriatric assessment, evaluation

TABLE 1 Human Cancers Whose Clinical Behavior May Change with Age


Change in prognosis

Change in tumor behavior


Acute myeloid leukemia


Breast cancer



Celomic cancer of the ovary


Nonsmall cell Better?

cancer of the lung

Decreased responsiveness to chemotherapy

Increased risk of recurrence after remission More indolent course

Decreased responsiveness to chemotherapy Decreased disease-

free survival More indolent course?


Increased prevalence of multidrug resistance Increased prevalence of unfavorable cytogenetics changes Increased prevalence of multilineage leukemia Soil:

Increased concentration of

Il6 in the circulation? Seed:

Increased prevalence of well differentiated, hormone-receptor rich cancers Soil:

Endocrine senescence and possibly immune senescence Unknown


More common cancer in ex-smokers?

Abbreviation: NHL, non-Hodgkin's lymphoma.

of laboratory parameters, or proof of physical functions (Table 2) (26-28). These forms of assessment have been extremely helpful in several areas including:

1. Recognition of individuals who are unable to tolerate even minimal stress due to exhausted functional reserve

TABLE 2 Examples of Instruments Currently Used to Estimate an Older Person's Life Expectancy and Functional Reserve

Clinical geriatric assessment

Laboratory tests

Proofs of physical function

CGA Function Comorbidity Nutrition Polypharmacy Mental status Social support Abbreviated forms of geriatric assessment Vulnerable elderly survey (VES-13) CHS

San Francisco VA assessment


C-reactive protein Hemoglobin

Timed "get-up and go" test Strength of upper and lower extremities

Abbreviations: CGA, comprehensive geriatric assessment; CHS, cardiovascular health study.

2. Recognition of individuals whose function and life expectancy may be improved by treatment of underlying diseases, social support, management of nutrition, and polypharmacy and physical rehabilitation

3. Estimate of short- and long-term mortalities

4. Risk of short- and long-term disabilities

The main limitations of these forms of assessment include labor intensity, in the case of the comprehensive geriatric assessment (CGA), redundancy, and, most importantly, inability to provide more precise information as to the risk of death, disability, and treatment complications of each individual.

For what concerns tumor aggressiveness, it is assumed that current prognostic factors, such as histologic differentiation, s-phase, proteomics, and genomics, have the same value in all patients irrespective of age. The role of the tumor host (the soil) in modulating tumor growth is unestablished, however.

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