Treatment of cancer in old age, shortcomings and challenges

The burden of cancer in old age is increasing as a result from both the exp anding number of older persons in the population and the high and still inc reasing cancer incidence in this group. The goal of this article is to outl ine the shortcomings and challenges of the management of cancer in the elde rly. Several factors contribute to the complexity of this management, such as the enormous heterogeneity in this population, increased cc-morbidity, r educed functional status, increased frailty and different treatment goals f rom those in younger patients. Other problems include the lack of data on t he efficacy and toxicity of cancer treatment in this age group, the lack of awareness of life-expectancy and the lack of an easy applicable and valida ted frailty scale. Improvement of the quality of oncological care in this a ge group could be achieved by initiation of clinical trials specifically di rected at the elderly, in which a frailty scale is implemented. The results of these trials may lead to more evidence-based decision making in cancer treatment in the elderly. (C) 2001 Elsevier Science B.V. All rights reserve d.