Aging Baby Boomers and Cancer: The Oncoming Burdens

Nick Mulcahy

May 05, 2009

May 5, 2009 — The aging of America will contribute to a 45% increase in the total number of annual cancer cases — from 1.6 million to 2.3 million — over the next 2 decades (from 2010 to 2030), according to a new cancer incidence report published online April 29 in the Journal of Clinical Oncology.

By 2030, Americans 65 years and older will account for 70% of all cancer diagnoses — up from about 61% of current cases, says the report.

The expected increase in cancer as the Baby Boomer generation ages is a daunting clinical and political challenge, suggested June M. McKoy, MD, who is the lead author of an editorial that accompanies the cancer incidence report.

It is not politically popular to say, but we will need an increase in taxes.

"It is not politically popular to say, but we will need an increase in taxes," Dr. McKoy told Medscape Oncology. She is an assistant professor of medicine and preventive medicine at the Northwestern University Feinberg School of Medicine in Chicago, Illinois, and a member of the Robert H. Lurie Comprehensive Cancer Center.

"As a people, we can either get older or die. To live, we need to invest in healthcare," she said, adding that Medicare reform is also needed. "Medicare needs to be based on income and wealth. Not every older person needs Medicare, or at least a full benefit."

Clinically, the clock is ticking for the United States to make changes to address the coming cancer-care burden, suggest Dr. McKoy and her fellow editorialists. One of the challenges is training more oncologists, including geriatric oncologists. A 2006 study projected a shortage of 2550 to 4080 oncologists by 2020 in the United States, note the editorialists.

Other challenges include the need to assess all cancer treatments in terms of cost-effectiveness, write the authors of the cancer incidence report, led by Benjamin Smith, MD, chief of radiation oncology at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio, Texas.

"Phase 3 cancer clinical trials should begin to include cost-effectiveness analysis as a clinical end point," write the report authors. However, clinical trials have traditionally underrepresented older adults, observe Dr. Smith and his coauthors.

The problem here — and one that needs a solution sooner rather than later — is age bias, especially in industry-sponsored trials, said Dr. McKoy.

"This pertains to all disease, not just cancer," she said, explaining that there is an understandable bottom-line reason for studying younger patients — they tend to live longer and are more profitable as a patient group.

"In oncology, there needs to be a balance between drug development cost concerns and research that targets older patients, because these patients bear the overwhelming burden of cancer," she said.

Despite significant obstacles, the task of providing quality cancer care for all older Americans is feasible, suggest the editorialists. But change is needed very soon, said Dr. McKoy, who believes the Obama administration's interest in looking at the comparative effectiveness of medical treatments is a positive sign of a willingness to innovate in healthcare. "We have to meet the challenges of the future now," she said.

1980 to 2000 vs 2010 to 2030: More Cancer

In their report, Dr. Smith and coauthors from the University of Texas MD Anderson Cancer Center in Houston and City of Hope Cancer Center in Los Angeles, California, project that there will be a "marked increase" in cancer diagnoses in the next 20 years, including among minorities, as previously reported by Medscape Oncology.

To arrive at an estimate of the total increase, the investigators used data from the Surveillance, Epidemiology, and End Results (SEER) project and the United States Census Bureau, and assumed that cancer rates in 2003 to 2005 (by age and other factors, including race) will remain constant through 2030.

The leading cancers by body site in the year 2030 are still expected to be prostate (382,000), lung (189,000), and colorectum (136,000) in men; and breast (294,000 invasive and 67,000 in situ), lung (149,000), and colorectum (122,000) in women.

Cancer sites with the highest percentage of increase between 2010 and 2030 are expected to be stomach (67%), liver (59%), myeloma (57%), prostate (55%), pancreas (55%), bladder (54%), lung (52%), and colorectum (52%).

For patients 65 years and older, a more than 50% increase in incidence by 2030 is projected for every single cancer site examined.

The proportions of the overall cancer increase anticipated in the next 2 decades are not unprecedented. In fact, in that regard, things were worse from 1980 to 2000.

From 1980 to 2000, the population grew by 23% (from 227 million to 279 million); the projected growth from 2010 to 2030 is 19% (from 305 million to 365 million). From 1980 to 2000, the total yearly cancer incidence increased 66% (from 807,000 to 1.34 million). In the next 2 decades (2010 to 2030), the total yearly cancer incidence will also increase (from 1.6 million to 2.3 million), but the proportion change is 45%.

However, among the things that are different between the past 20 years and next 20 years are the total number of cancer cases and the percentage of cancer diagnoses among the elderly, note Dr. Smith and his colleagues.

These circumstances necessitate change, reiterated Dr. McKoy.

A number of "good steps" are already underway, she said, including the formation of the Cancer and Aging Research Group. The group concluded that a geriatric assessment be included in all clinical trials enrolling patients 70 years and older, write Dr. McKoy and her fellow editorialists. A tool such as the Comprehensive Geriatric Assessment (CGA) should be standard in the treatment of older (≥65 years) cancer patients and is the foundation for determining a patient's fitness for possible oncologic therapy, said Dr. McKoy. Currently, use of the CGA is common among geriatric oncologists but not among other subspecialties, she added.

The editorialists also remind clinicians that normal age-related changes alter the renal and hepatic systems and could put older patients at risk for serious adverse reactions from cancer drugs. "As we age, liver blood flow decreases. With any drug that is metabolized by the liver, you must dose the drug lower. The effectiveness can be the same, but we must avoid toxicities," said Dr. McKoy.

The researchers have disclosed no relevant financial relationships.

J Clin Oncol. Published online before print April 29, 2009. Abstract, Abstract


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