How aging of the global population is changing oncology

Abstract

Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between "physiologically older" and "physiologically younger" patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.

Keywords: clinical decision-making; demography; longevity; quality of life; supportive care.

Figure 1.. Comparison of the traditional chronological view of aging with a physiological (or “functional”, “biological”, etc.) viewpoint adapted for patients with a cancer diagnosis.

Figure 2.. Pathogenetic and socioeconomic interplays relevant to the changing physiological age-specificity of cancer demographics.

Figure 3.. Decision-making schematic showing influence of survival gains balanced with other factors including mechanistic interventions, quality of life strategies, and personal priorities.