Chronic conditions and cancer in older adults

Abstract

As a result of the progressive ageing of the population worldwide, an increasing number of older adults suffer from the sequelae of acute and chronic disease states. The latter are not confined to structural or functional impairments of individual organs or systems. Rather, they often impact on global domains of physical and cognitive function, leading to loss of independence, disability and frailty. An increasing number of older adults either suffer or have suffered, from cancer. Older cancer patients often have distinctive clinical features warranting consideration by healthcare practitioners, including significant co-morbidity burden, polypharmacy, and high inter-individual variability in homeostatic capacity, functional status and social circumstances. Although these factors are likely to influence cancer treatment options and follow-up, relatively little information is available on how to best screen, diagnose and manage this complex patient group. With the expected increase in the prevalence of older cancer patients, development and validation of dedicated care pathways, tailored to specific healthcare settings, are increasingly recognized issues in modern clinical practice. This chapter discusses general epidemiological principles of human ageing in the context of co-morbidity burden and cancer, the available information on the prevalence and outcomes of specific types of cancer in older adults, the interplay between cancer and other common disease conditions, the available tools to assess functional status and frailty in older cancer patients, and their role in clinical decision making in common cancer types in this group, namely prostate and breast cancer.