Shift in the burden of cancer towards older people--a retrospective population-based study.

Cancer is age-related. However, oncology and palliative medicine services focus on the needs of younger and middle-aged adults. This study examined trends in cancer deaths across age in Wales over the last 20 years. All Wales death certificates from 1981 to 2001 were examined for total and cancer deaths. Place of death and age were noted. Total deaths decreased from 35 015 in 1981 to 32 966 in 2001 while cancer deaths increased from 7369 (21.1% of all deaths) to 8292 (25.2%). Deaths due to cancer increased in the over 85 years from 9.1% to 13.1%, 75-84 years (17.1-25.2%), 65-74 years (25-35.7%), 45-64 years (33.5-40.4%) and fell from 18.3% to 16.1% in those under 44 years. Cancer deaths over 75 years increased from 33.6% of cancer deaths in 1981 to 50.1% in 2001. Cancer deaths in the community decreased from 2713 in 1981 to 2153 in 2001 and increased in hospital from 4398 to 5185 and care homes from 258 to 954. The increase in hospital cancer deaths is mainly because of 75-84 year olds (1207-1840), and the over 85 years (294-740). Half of all cancer deaths are now in those over 75 years. Cancer deaths have shifted from the community to hospital and care homes mainly because of cancer in older people. Services need to be developed to target this population.