Age: a critical factor in cancer management. A prospective comparative study of 400 patients

Background: older people are often excluded from cancer treatments solely o n the grounds of age. Aims: to compare cancer treatment in older and younger patients. Patients and methods: between June 1992 and September 1994, 400 cancer pati ents were included in this prospective comparative study. The factors compa red between younger and older subjects were performance status, associated chronic diseases, delay in diagnosis, stage of disease and initial treatmen t. Results: 54 patients (25.5%) under 70 years of age were asymptomatic at the time of diagnosis, in comparison with 25 (12.5%) of the 200 older patients (P < 0.001). Associated chronic pathologies were more frequent in the olde r patients (55% vs 18.5%, P < 0.001). There were no statistical differences between both groups in diagnostic delay. Localized disease was found in 12 7 (63%) of the younger patients and in 109 (54%) of the older patients, the difference not being significant. The percentage of patients who underwent oncological treatment was higher in the lounger than the older group (87.5 % vs 56%, P < 0.001). The main cause of therapeutic exclusion in both group s was poor performance status; however, in the older group other variables - such as the presence of chronic disease and patients' or relatives' wishe s and doctors' opinions-influenced the decision not to give specific treatm ent. Conclusions: this study confirms that the clinical characteristics and trea tment of aged people with cancer are different from those of younger patien ts. Nevertheless, there is considerable doubt about whether an arbitrary ag e limit should continue to be accepted as a discriminatory factor in some d iagnostic and therapeutic procedures in cancer patients.