Cancer in the Very Elderly and Management

The very elderly population defined as 85 years and over is expected to reach ten million in the USA by 2030, almost double current figures. The risk of cancer increases with age with peak incidence occurring between 65–85 years. The cancer mortality rate increases with age but is not the leading cause of death in the very elderly. Aggressive cancer therapy in older patient ≥85 years would not have been a consideration by many clinicians which is reflected in the age limit of the inclusion criteria of clinical trials in the last 10–20 years. An overwhelming number of trials in oncology have been in the fittest patients and cannot be universally applied to the elderly where a decline in organ function can vary considerably between patients. The comprehensive geriatric assessment (CGA) tool is the most robust method available for assessing global fitness in the elderly to determine the suitability of treatment. The challenge clinicians face is balancing the benefit of treatment against the risk and ensuring elderly patients receive optimal care. This chapter focuses on management of common solid tumours (breast, prostate, lung and colorectal) in the oldest-old and the issues encountered in practice in this population.