World cancer day is an international day marked on 4th February each year, to raise awareness about cancer and to encourage its prevention, detection and treatment. Administering the optimal treatment to elderly patients with cancer remains challenging, because of the age limits, social factors and the co-morbidities that decrease the drug tolerance and increase the toxicity of therapies.
In elderly, cancer is one of the predominant causes of mortality and morbidity; 70%of cancer related deaths occur in patients above 65 years of age. The world’s population is ageing rapidly. There are currently over 703 million people worldwide above 65 years of age and estimated data suggest that this population may rise to 1.5 billion by 2050, more than the total population of India or China.
Cancer can develop at any age but it is showing a dramatic rise in older population. As per GLOBOCAN 2020, more than 50% of people, who have cancer are above 65 years of age or older. In Kashmir 5285 patients were diagnosed with cancer in 2022 at state cancer institute of SKIMS. Out of which 45 % were above 60 years of age. Surprisingly the cancer above 60 years of age is more common among males (55%) than females (45%). Possibly because of the rise in lung cancer which has surpassed the cancer of esophagus, which was more common ranking no.1, for last several decades, has shown slight decline; it is now at no. 2 of top 10 cancers. Similarly there is a rise in Prostate cancer which is among top 10 cancers accounts 2.34 % of all cancers, diagnosed in 2022.
The rise of cancer in older population can be directly related to the risk factors, that one interact with in the childhood /teen age, as it is the persistent irritation and the cumulative effect of the risk factors like smoking, alcohol intake, drug addiction, sedentary life style, unhealthy diet, that play a major role in the development of cancer. It takes more than 20-30 years for a carcinogen/risk factor to mutate a normal cell that becomes abnormal and results in to cancer. With age the cellular repair mechanism also becomes less effective. Besides the risk factors that make intrinsic cellular changes, the other bodily processes, like the immune system becomes less efficient in detecting and fighting infection and diseases including cancer. There is much still to learn about providing the best treatment to the older patients, who have unique type of health issues like the anxiety, stress, depression because of the psychosocial, family issues like the studies, job, marriage, issues of their children which are yet to be settled.
Another challenge, in older people is that the cancer is being diagnosed at an advanced stage, because the early symptoms of cancer are being mistaken or related to age for every day pain, for benign illness, like Diabetes, Arthritis, Hypertension, chronic disease of lung, heart etc. As a result the treatment starts late, which increases the likelyhood of side effects and reduces the chances of a successful outcome, hence poor survival. Furthermore the treatment of cancer in elderly is more challenging because of the co-morbidities that result in restriction of specific cancer drugs /dosage or need modifications.
Geriatric oncology and palliative care is rapidly developing in this direction as separate disciplines in oncology, to provide guidelines for managing of elderly cancer patients, where the preferences, capacities and specific aspects of age are taken into consideration; this, in order to deliver care and maintain individual’s quality of life. Now when the population is ageing, the risk of developing cancer will increase, result will be a major health burden in coming years. The need of the day is to include older people in to discussion about cancer, make them aware about the prevention and early detection. If disease is detected at an early stage the chances of cure are very high, like in stage 1 breast cancer, survival is as high as 90%, in Prostate cancer 80% and even in lung cancer it is more than 60%.
In conclusion, I want to share the good news with the general public that prophylaxis is the best way to defeat cancer. So if you want to live a healthy, happy life, let us follow following guide lines:
= Maintain a healthy body weight.
= Restrict intake of processed or red meat.
= Take 2-3 servings of fresh fruits and vegetables daily.
= Prefer whole wheat bread rather than refined cereal products.
= Avoid smoking in any form.
= Avoid alcohol intake.
= Engage yourself in activities.
= Restrict sedentary life.
= Be positive. Be happy.
Dr. Nazir Ahmad Khan, Professor, Department of Radiation Oncology, SKIMS