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Increased number of elderly patients with cancer: general overview

Increased number of elderly patients with cancer: general overview. ESTRO 31. Dr. V. Lemmens Head of Research Department Eindhoven Cancer Registry / Comprehensive Cancer Centre South. Demography (= births , deaths , and migration).

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Increased number of elderly patients with cancer: general overview

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  1. Increased number of elderly patients with cancer: general overview ESTRO 31 Dr. V. Lemmens Head of Research Department Eindhoven Cancer Registry / Comprehensive Cancer Centre South

  2. Demography (= births, deaths, and migration) Ageing population in Europe, caused by economical, social, and medical progress • Post-war ‘baby boom’ followed by ‘baby crash’ • Average number of children per woman dropped to 1.6, while 2.1 is replacement level • Life-expectancy rose by 8-9 years between 1960 and 2010, expected to increase even more up to 2050 : 89 years for women, 84.5 for men

  3. Demography NL Age (yrs) 1950 (10 million) Males Females Born in 1946 N (x 1000) N (x 1000)

  4. Demography NL Age (yrs) 1980 (14.1 million) Males Females Born in 1946 Born in 1975 N (x 1000) N (x 1000)

  5. Demography NL Age (yrs) 2010 (16.6 million) Born in 1946 Born in 1975 Females Males N (x 1000) N (x 1000)

  6. Demography NL Age (yrs) 2030 (17.7 million) Born in 1946 Born in 1975 Females Males N (x 1000) N (x 1000)

  7. Demography NL Age (yrs) 2060 (17.7 million) Born in 1975 Females Males N (x 1000) N (x 1000)

  8. Demography • However: large differences between countries within Europe!

  9. Demography EU Source: EUROSTAT

  10. Demography EU • In 2050, 1/3 of the population will be 65 years or older • The median age will increase from 40 to 49 years, proportion 80+ will triple by 2060 • Let’s take a look at the various countries…

  11. Proportion aged 65 and overper country Source: EUROSTAT

  12. Proportion aged 65 and overper country Source: EUROSTAT

  13. Dependency ratio across Europe • Old-age-dependency ratio: • Ratio between the total number of elderly persons of an age when they are generally economically inactive (aged 65 and over) and the number of persons of working age (from 15 to 64) • Important for healthcare planning!

  14. Dependency ratio across Europe: 2009 Source: EUROSTAT

  15. Dependency ratio across Europe: 2060 Source: EUROSTAT

  16. Dependency ratio across Europe: 2010 vs 2060 2010 2060

  17. Ageing trends by country • Italy and Germany will reach the ageing peak already at 2030 • Others (mainly eastern Europe) will peak at 2060, and will then have by far the most old populations

  18. Fertility in EU • Number of births decreasing since 1964, however:

  19. Fertility rates and maternal age across Europe

  20. Life expectancy • Life expectancy increased throughout Europe • In 2009, 76.4 yrs for males, and 82.4 yrs for females • But also here, large differences between countries within Europe

  21. Life expectancy at birth (males)

  22. Life expectancy at birth (females) Source: EUROSTAT

  23. Life expectancy at 65 (males) Source: EUROSTAT

  24. Life expectancy at 65 (females) Source: EUROSTAT

  25. Increased life expectancy • Healthy life expectancy has been increasing relatively more than overall life expectancy

  26. Increased life expectancy • Rise in life expectancy (1993-2009) lowest in Bulgaria (2.4 yrs, M&F), and highest in Estonia (7.5 yrs for M, 6.2 yrs for F) • Where in life is the gain made? Source: EUROSTAT

  27. Age and cancer Absolute number of patients newly diagnosed with cancer, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  28. Age and cancer Largest number of patients is aged 65-69 (median age=69) Absolute number of patients newly diagnosed with cancer, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  29. Age and cancer Number of patients newly diagnosed with cancer per 100.000 inhabitants of same age group, the Netherlands Source: Netherlands cancer Registry

  30. Age and cancer 2010 RISK of cancer highest in 80-84 yrs age group 2030 Larger proportion of population with high risk of cancer > median age of cancer shifts towards higher age

  31. Distribution by age Males, 65-74 yrs Males, 85+ yrs Source: Netherlands cancer Registry

  32. Distribution by age Females, 55-64 yrs Females, 75-84 yrs Source: Netherlands cancer Registry

  33. Melanoma skin cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  34. Prostate cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  35. Breast cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  36. Cancer of unknown origin • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  37. Lung cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Males 1989 Males 2010 Females 2010 Females 1989 Source: Netherlands cancer Registry

  38. Oesophageal adenocarcinomamales • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  39. Gastric cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  40. Colorectal cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  41. Bladder cancer • Number of patients newly diagnosed with cancer per 100.000 inhabitants, the Netherlands, by 5-yr age group Source: Netherlands cancer Registry

  42. Cancer at very high age • Of all malignancies, 6% occur at the age of 85 yrs or later • Of all non-melanoma skin cancer, 15% is ≥ 85 yrs • Bladder: 10% • Stomach 8% • Breast 8% • Primairy tumour unknown: 10%

  43. Comorbidity Source: Eindhoven Cancer Registry

  44. Comorbidity Source: Eindhoven Cancer Registry

  45. Comorbidity • Increase in comorbidity rates • For example, colorectal cancer: Source: Eindhoven Cancer Registry

  46. Comorbidity Diabetes and colorectal cancer Diabetes (%) Colon cancer Rectal cancer Year of diagnosis Source: Eindhoven Cancer Registry

  47. Comorbidity • Increase largest for diabetes, cardiovascular disease, and hypertension • No increase for COPD • So especially diet / physical activity related comorbidity becoming more important

  48. Treatment • Relation age / comorbidity and less aggressive treatment often described in literature • Elderly however increasingly aggressively treated!

  49. Treatment Trend % chemotherapy M1 75+ yrs Source: Eindhoven Cancer Registry

  50. Treatment • No increasing trend in the proportion of patients with cancer that has undergone radiation treatment as part of primary treatment • But due to the vast increase in the absolute number of patients with cancer, the demand for radiotherapy between 2010 and 2020 is expected to increase by 22%* • Growing demand for (training of) radiation oncologists, technologists, etc! * Smith BD et al, JCO 2010

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