Abstract
The present study is aimed to compare survival and prognostic changes over time between
elderly (70–84 years) and middle-aged cancer patients (55–69 years). We considered
seven cancer sites (stomach, colon, breast, cervix and corpus uteri, ovary and prostate)
and all cancers combined (but excluding prostate and non-melanoma skin cancers). Five-year
relative survival was estimated for cohorts of patients diagnosed in 1988–1999 in
a pool of 51 European populations covered by cancer registries. Furthermore, we applied
the period-analysis method to more recent incidence data from 32 cancer registries
to provide 1- and 5-year relative survival estimates for the period of follow-up 2000–2002.
A significant survival improvement was observed from 1988 to 1999 for all cancers
combined and for every cancer site, except cervical cancer. However, survival increased
at a slower rate in the elderly, so that the gap between younger and older patients
widened, particularly for prostate cancer in men and for all considered cancers except
cervical cancer in women. For breast and prostate cancers, the increasing gap was
likely attributable to a larger use of, respectively, mammographic screening and PSA
test in middle-aged with respect to the elderly. In the period analysis of the most
recent data, relative survival was much higher in middle-aged patients than in the
elderly. The differences were higher for breast and gynaecological cancers, and for
prostate cancer. Most of this age gap was due to a very large difference in survival
after the 1st year following the diagnosis. Differences were much smaller for conditional
5-year relative survival among patients who had already survived the first year.
The increase of survival in elderly men is encouraging but the lesser improvement
in women and, in particular, the widening gap for breast cancer suggest that many
barriers still delay access to care and that enhanced prevention and clinical management
remain major issues.
Keywords
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Article info
Publication history
Published online: January 05, 2009
Accepted:
November 4,
2008
Received in revised form:
September 25,
2008
Received:
June 4,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
