Cancer is still a leading cause of death in the United States, but advances in radiation, chemotherapy and targeted treatments have improved survival, the researchers said.
“Although survival rates for most cancers have improved over the past few decades, the improvements were less remarkable among elderly patients,” said lead researcher Dr. Wei Zheng, co-leader of the Cancer Epidemiology Research Program at the Vanderbilt-Ingram Cancer Center in Nashville.
The study also found differences in survival based on race. Overall, blacks had poorer survival than whites. Black women with ovarian cancer experienced a decrease in survival over the past two decades for unknown reasons, he said.
“Black Americans experienced poorer survival than whites for all cancers during the study period,” Zheng said.
The report was published Feb. 19 online in JAMA Oncology.
Zheng and his colleagues analyzed data on just over 1 million patients diagnosed with cancer of the breast, colon or rectum, prostate, lung, liver, pancreas or ovary from 1990 to 2009. Those included in the study were part of the U.S. National Cancer Institute Surveillance, Epidemiology and End Results program.
The researchers found that the odds of survival increased significantly for many patients aged 50 to 64. For example, patients from this age group diagnosed with colon and rectum cancer from 2005-2009 had a 43 percent lower risk of death, compared with similar patients diagnosed from 1990-1994.
Also among the 50-to-64 age group, the reduction in risk of death was 52 percent for breast cancer, 39 percent for liver cancer and 68 percent for prostate cancer in 2005-2009, compared to 1990-1994.
For patients aged 75 to 85, however, the risk of death was reduced only 12 percent for those with breast, colon or rectum cancer. For liver cancer, the reduction was 24 percent in older patients, and for those older men with prostate cancer, the risk of death was reduced 35 percent, the researchers found.
Researchers found similar, though smaller, improvements in survival for lung and pancreatic cancers.
Because of greater improvements in prostate cancer survival among blacks than whites, the racial difference in prostate cancer survival has decreased, Zheng noted.
“For ovarian cancer, however, the survival rate declined in blacks but slightly increased in whites, leading to a wider racial gap in the survival of this deadly cancer,” he said.
“It is important to identify reasons for the slower improvement in cancer survival in elderly Americans and reduced survival rate of ovarian cancer in black women to guide future improvement in cancer care for all,” Zheng said.
Dr. Otis Brawley, chief medical officer for the American Cancer Society, attributed most of what the study found to “improvements in treatment and the tendency to treat younger people more aggressively than older people.”
Giving more aggressive treatment to younger people is often the right thing to do, Brawley said. A concern with older patients is that they may have other chronic conditions that make aggressive chemotherapy or radiation risky, he said. “You can actually get older people into a great deal of trouble by treating them aggressively,” he added.
Sometimes, though, it is appropriate to treat older patients aggressively, Brawley said. Older patients should discuss their treatment with their doctors to be sure they’re getting the best care based on their cancer and overall health, he added.
“Every patient and every patient’s family should have a good conversation with their doctor about their treatment and the appropriateness of the treatment for their age,” Brawley said.