Impact of age and comorbidity on treatment and outcomes in elderly cancer patients.

Cancer is a prevalent disease in elderly patients, who are also more likely to have comorbid illnesses than younger patients. Both increasing age and comorbidities are associated with a lower use of aggressive cancer therapies-including surgery, chemotherapy, and radiation therapy-but age is often the stronger determinant. A large proportion of elderly but otherwise healthy cancer patients do not receive aggressive treatments. Although there is an underrepresentation of elderly patients in clinical trials, the available evidence suggests that elderly patients can derive similar survival benefits from aggressive treatments as younger patients. For certain cancers and treatments, elderly patients may experience higher rates of toxicity and therefore require closer monitoring. Patients with comorbid illnesses have worse health-related quality of life at baseline but experience a similar health-related quality of life decline from treatment as healthier patients. However, patients with significant comorbidities are less likely to derive benefit from aggressive treatments. There is a need for studies to better identify, at baseline, patients who are likely to benefit from and tolerate aggressive treatment. A systematic use of sophisticated assessments, such as the geriatric assessment, may allow physicians to select appropriate patients and reduce underutilization of aggressive treatments in elderly cancer patients.