HOLLYWOOD, Fla., March 27, 2008 —Americans older than 65 years are expected to double from 40 million in 2010 to 80 million in 2040. This will lead to a large increase in breast cancer among American women, the leader of a task force reported during the National Comprehensive Cancer Network’s 13th Annual Conference.
But is the medical community ready? Stanford oncologist and Professor Robert W. Carlson, M.D., who chairs NCCN’s task force on breast cancer in the older adult, says many questions are unanswered. Treatment of women older than 70 is often summed up in footnotes that simply acknowledge lack of data.
The task force, which consists of medical doctors and a patient advocate, considered whether the NCCN Clinical Practice Guidelines in Oncology™: Breast Cancer should be expanded to include separate instructions concerning elderly patients. However, because women over age 70 are underrepresented on clinical trials, too few facts exist to underpin a more helpful recommendation.
Currently the median age of women diagnosed with breast cancer is 61 years, a number likely to go up as baby boomers create a “ripple,” Carlson explains. Advanced age complicates decisions about cancer regimens not only because older women may need extra supportive therapies to survive the stress of cancer treatment, but also because lifespan is an issue. “The benefit of treatment has to be bigger in a relative sense to be worth it in an absolute sense in the older patient because of competing causes of death.”
New tests are “desperately needed” to determine an elderly patient’s physiologic age so that her doctor can make wise recommendations regarding surgery, chemotherapy and radiation, Carlson says. Oncologists will look to geriatricians to abbreviate current tests of a patient’s functioning. To be useful in the context of cancer treatment, tests that can take from two to three hours to administer must be distilled to five-minute formats.
Carlson outlines several “research issues important to address over the next decade:”
Proceedings of the task force are scheduled to be published in an upcoming supplement to JNCCN – The Journal of the National Comprehensive Cancer Network.
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 23 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.