Because of advances in medicine, a better understanding of how to prevent certain illnesses (such as heart disease), and more emphasis on healthy living, people in the United States are living longer. On average, women born today are expected to live 85 years, and men are expected to live 77 years. In fact, by the year 2050, 79 million people will be older than 65.

The single greatest risk factor for developing cancer is aging. According to studies done by the National Cancer Institute (NCI), the number of new cancer cases is about 10 times greater for people 65 years and older, and about 60% of all cancers occur in this age group. Cancers of the prostate, breast, colon, pancreas, bladder, stomach, lung, and rectum are the most common cancers occurring in people over 65.

Aging is a process that changes a healthy young adult into an older, potentially less healthy person, with an increased risk of illness, injury, and death. The aging process is complex and can weaken a person's ability to resist disease and disability. Aging may also affect a person's well-being, independence, and feelings of self-worth.

Physical changes associated with aging and their relationship to cancer

Many older people experience physical changes that increase the chance of disease and disability and, if cancer is present, may interfere with cancer therapy. In addition, age is associated with a gradual inability to accomplish daily activities, such as dressing, bathing, and using the toilet without assistance. These abilities are measured by two indices called the Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL). Older adults who are dependent in these areas have a lower life expectancy and tolerance of stress, including the stress of cancer treatment.

Older adults are more likely to have chronic illnesses that can affect their life expectancy and ability to handle stress. Examples of chronic illnesses that often accompany the aging process include:

• Heart problems
  
  
• Decreased kidney function
  
  
• Memory loss
  
  
• Vision loss
  
  
• Hearing difficulties
  
  
• Poor nutrition
  
  
• Weight loss, which can be caused by poorly fitting dentures, loss of teeth, and depression
  
  
• Loss of appetite, especially from certain medications

Each person ages at a different rate, and actual age is a poor mirror of physiologic age (an estimation of age based on how a person functions). Evaluation of function and co-existing illnesses is important when estimating a person's life expectancy and tolerance for stress.

Older age and undertreatment

Even though cancer occurs most often in the older population, older people often receive less frequent screening for cancer, fewer tests to stage the type of cancer, and may receive milder treatments or no treatment at all. According to a study published in the November 15, 2004, issue of the Journal of Clinical Oncology, people with cancer over age 65 are significantly under-represented in cancer clinical trials. Other studies also support this conclusion.

Furthermore, many studies have shown that cancer treatment is beneficial for older people. Although some people associate older age with poor health, age alone should not determine treatment options. For example, an older person's overall health and ability to perform daily activities should also be evaluated. It is important that both the older person with cancer and his or her family be given enough information about treatment options, especially the risks, benefits, and goals of treatment to make an informed choice with respect to treatment. People young and old have various goals and may make good yet different decisions when faced with treatment choices. Age, if anything, emphasizes physical differences and gives older people with cancer a right to determine what is in their best interest.

Emotional concerns and practical issues

Older people with cancer often have a different set of concerns than other adults with cancer, which may affect how the older person will cope with cancer and includes the following:

Maintaining independence. For many older people with cancer, the biggest concern is maintaining as much independence as possible. Many older people want to be able to take care of themselves and feel they are still in control of their health and decisions. Cancer treatment may interfere with the ability to cook and eat independently, wash or bathe independently, walk, drive, or access transportation. Having to rely on others to care for them may not only be overwhelming, but may not even be possible, especially if there are no family members or friends around to act as caregivers. In addition, many older people experience the loss of their primary caregiver, such as a spouse, and may not have other supportive adult relationships.

Feelings of social isolation. Older people with cancer are less likely to have a support system in place, often because they have relocated to a new home or apartment, do not live close to family, or have experienced the loss of family members or friends. Sometimes, being isolated brings up feelings of depression and anxiety, which may interfere with treatment. Furthermore, coping with problems associated with cancer treatment may become difficult. Community resources, such as visiting nurse services and other agencies, can be set up ahead of time so the older adult does not experience cancer alone. Sharing one's concerns with doctors and social workers may provide useful tips and contacts with local resources.

Spiritual concerns. Spiritual and religious concerns may also factor into decisions about cancer treatment. As with other issues, effective communication among the person with cancer, a social worker, family members, and trusted members of the religious community may be helpful.

Financial concerns. For an older adult, retirement, the death of the primary wage earner, and existing financial problems can contribute to limited financial resources to pay for cancer treatment and other related costs. It is important to discuss these needs with a health-care provider, as there are many resources available to help. More information on this topic can be found in Cancer in Daily Life.

Physical limitations. Many pre-existing medical problems may limit an older person's physical abilities and their mobility. Creating a safe physical environment at home can help them cope. Simple measures, such as improving lighting, clearing the clutter in the home, and installing safety railings in stairs or bathrooms, may help minimize accidents or falls. A social worker or a visiting nurse service can help assess the home environment and suggest changes.

Transportation. Access to treatment depends on reliable transportation. Older people undergoing cancer therapy may have a difficult time getting to various appointments, especially if the person no longer drives and is dependent on other transportation. Nurses and social workers may be able to assist with transportation needs in order to allow the older adult to receive appropriate cancer care.