FCRP Policy Statement

The single greatest risk factor for cancer is age. More than 50% of all cancers in the United States occur in individuals over the age of 65. A corresponding increase in the national prevalence of cancer is expected as the number of older Americans increases. Thirteen percent of Americans are now over the age of 65 and by the year 2030, the Census Bureau predicts that one in every five Americans (20%) will be over the age of 65.

The increased incidence of cancer in the elderly is believed to be related to:

• an individual's length of exposure to carcinogenic agents
• age-related changes that alter the body's sensitivity to carcinogens
• inaccurate and diminished DNA repair systems
• immune system changes that interfere with the surveillance and destruction of mutated cells

Typically, cancer diagnosis and treatment of the elderly is complicated by a combination of social, psychological, educational, financial, cultural, and economic factors. Elderly persons may delay seeking health care due to lack of knowledge regarding the significance of symptoms, educational or attitudinal barriers to getting information, social isolation, pessimism regarding cancer and its treatment, disorders such as depression or dementia, or because of low economic status or concerns about costs.

The elderly are underserved in detection and screening efforts and are frequently uninformed as to their increased risk of cancer. Diagnosis may often be delayed due to unrecognized or unreported symptoms. Symptoms of cancer may be attributed to other chronic diseases or to "getting old." Pamphlets and other educational materials are not often geared to the abilities and needs of the elderly population. The chance for cure diminishes if a person is diagnosed late in the disease course, and the older American is at risk of this.

Derisive attitudes towards the elderly population have impeded early cancer prevention, detection, treatment, and rehabilitation efforts. Elderly patients (especially those with cancer) account for a high percentage of the escalating costs of health care in the United States. Attention is needed to address the cancer care diagnosis and treatment problems of older cancer patients. Coordination is needed to ensure early and state of the art care for this population.

Policy Recommendations

• A program focusing on screening and early detection for the elderly should provide a comprehensive range of care to maintain and enhance self care independence.
• Legislation that ensures funding of cancer services for the elderly which focus on screening and early detection. (Screening tests are often not covered by Medicare).
• Collaborative educational programs geared towards the elderly regarding cancer screening and early detection guidelines need to be fostered with groups such as the American Cancer Society, Offices of Aging, local senior centers, and other community groups.
• Increasing public and professional awareness about the early signs and symptoms of cancer in the older American population.
• Programs which focus on reaching elderly persons in secluded, isolated, or distanced locales who might otherwise not be aware of their risks of cancer or aware of services available in their own communities.

From Fact Sheet: Cancer and the Elderly, Oncology Nursing Society (1993). Research supported by grant #RO1 CA56338, "Rural Partnership Linkage for Cancer Care," funded by the National Cancer Institute.