The workshop, Exploring the Role of Cancer Centers for Integrating Aging and Cancer Research, was organized by the National Institute on Aging (NIA) and the National Cancer Institute (NCI) to provide a forum for leaders in cancer and aging research to express their views on pressing research needs. Representatives from the NCI-designated cancer centers were invited to formulate research priorities specifically focused on persons 65 years and older, the age group most vulnerable to cancer and in which the highest cancer incidence and mortality rates occur.
Advancing age is a high risk factor for cancer. Close to 60% of all newly diagnosed malignant tumors and 70% of all cancer deaths are in persons 65 years and older according to the NCI Surveillance, Epidemiology, and End Results (SEER) program data for 1994–1998. The age-adjusted cancer incidence rate for persons 65 years and older (2151.2 per 100,000 population) is ten times greater than the rate for persons under 65 years (208.8 per 100,000 population). The age-adjusted cancer mortality rate (1068.3 per 100,000 population) for persons 65 years and older is over 15 times greater than the rate for persons under 65 (67.3 per 100,000 population). Pancreas, stomach, rectum, lung, leukemia, non-Hodgkin’s lymphoma, liver, kidney, and ovarian cancers account for two-thirds to three-quarters of cancer deaths in persons age 65 years and older. Over 75% of cancer deaths are due to urinary bladder, colon, and corpus uterine cancers. Breast cancer accounts for 59% of deaths in women in this age group. Ninety-two percent of prostate cancer mortality occurs in men 65 years and older.
The cancer statistics showing the disproportionately high burden of cancer for older Americans take on even greater significance when cast against the changing demographics of the aging population in the United States. The number of older persons diagnosed with cancer is expected to increase because of the overall aging of the U.S. population and an unprecedented expansion of the 65 years and older age group in the next three decades.
Three factors contribute to our nation's changing age structure: changing mortality patterns, decreased fertility, and the aging of the baby boom cohort born between 1946 and 1964 (75 million persons). These factors, in particular the aging of the baby boom generation, will have far-reaching effects on the future overall health status and cancer burden of Americans. This phenomenon must be factored into our cancer research efforts. By 2030, 20% of the U.S. population will be 65 years and older. Age shifts within the 65 years and older segment of the population will increase the proportion of persons 85 years and older from our current 4.3 million to 8.9 million individuals over the next decades.
Participants in the NIA/NCI workshop were asked to identify a concise set of priorities to address the aging/cancer research interface that were consistent with the research themes developed by the workshop planning committee for each of the seven participating working groups. They were to:
The focus designated by the workshop planning committee was on human cancer. Participants were encouraged to make recommendations for research implementation and research barriers as well.
The NIA/NCI workshop was convened on the NIH Campus, Bethesda, MD, June 13–15, 2001. Two plenary sessions (held in the Lister Hill Center Auditorium) and the seven breakout groups (convened in the Natcher Conference Center) provided the forum and setting for brainstorming and the exchange of ideas and insights from participants. Each breakout group was Co-Chaired by two representatives from the cancer centers who were selected at the NIA/NCI workshop planning meeting. Seven scientific presentations were incorporated into the first plenary session to orient participants for their breakout group sessions. Breakout group reports were presented in the second plenary session.
Approximately 120 individuals—medical oncologists, geriatricians, health professionals, basic scientists, social scientists, epidemiologists, patient advocates, NIA and NCI staff, and others from relevant disciplines and professions participated in the NIA/NCI workshop. One or more participants, including 17 cancer center directors and senior program leaders, represented 44 of the 50 NCI comprehensive and clinical centers. Two of the ten basic science centers were represented. Dr. Richard J. Hodes, Director, NIA, and Dr. Richard D. Klausner, Director, NCI, welcomed workshop participants. Dr. John H. Glick, Director, University of Pennsylvania Cancer Center, chaired the workshop.
Many valuable suggestions were derived from the plenary and breakout group discussions. The full report identifies the domain of research issues and concerns that cut across institute, disciplinary, and professional boundaries and call for the integration of aging and cancer research. The Working Group Co-chairpersons, speakers, and themes are identified and abbreviated versions of the research priorities are indicated below.
Group 1. Patterns of Care [studies with a focus on older patients using both prospective and retrospective data that could include community-based studies, patient management, cancer site-specific studies, and maximizing existing data (e.g., SEER special studies, HCFA linkage, tissue banks, family network studies)]
Co-Chairs:
Paul F. Engstrom, M.D., Fox Chase Cancer CenterJerome W. Yates, M.D., M.P.H., Roswell Park Cancer Institute
Speaker:
Vincent Mor, Ph.D., Brown University
Group 2. Treatment Efficacy and Tolerance [clinical trials, pharmacology of anti-cancer drugs, radiation therapy, surgery, available technology, other modalities, characterization of inadmissible older patients to clinical trials]
Richard L. Schilsky, M.D., University of Chicago Joel E. Tepper, M.D., University of North Carolina School of Medicine
Richard L. Schilsky, M.D., University of Chicago
Group 3. Effects of Comorbidity on Cancer [studies could include problems of diagnosis and treatment, disability, functional limitations, assessment, recurrence, detection of second primaries]
Hyman B. Muss, M.D., University of Vermont Kathy Albain, M.D., Loyola University
William A. Satariano, Ph.D., M.P.H., University of California, Berkeley
Group 4. Prevention, Risk Assessment, and Screening [impediments for older-aged persons asymptomatic or with symptoms precluding their entrance to the preventive and health care system (e.g., delay behavior, insufficient knowledge of cancer risk), changes that occur in cancer risk as a function of aging]
Co-Chairs and Speakers:
Jeanne Mandelblatt, M.D., M.P.H., Lombardi Cancer Center Lodovico Balducci, M.D., Lee Moffit Cancer Center
Group 5. Psychological, Social, and Medical Issues [quality of life, quality of cancer survival, family and caregiver resources, early and late effects of treatment, quality cancer care, tumor recurrence, multiple primary tumors]
Patricia A. Ganz, M.D., Jonsson Comprehensive Cancer Center, University of California, Los AngelesAlice B. Kornblith, Ph.D., Dana-Farber Cancer Institute
Group 6. Palliative Care, End of Life Care, and Pain Relief [studies focused on patients with advanced cancer and associated issues in palliative care including caregiver and family support]
Nora Janjan, M.D., University of Texas, M.D. Anderson Cancer Center Ruth McCorkle, R.N., Ph.D., F.A.A.N., Yale University
Kathleen M. Foley, M.D., Memorial Sloan-Kettering Cancer Center
Group 7. Biology of Aging and Cancer [genetics, molecular signatures, bench to bedside application, translational research, age-related changes as they contribute to mortality, a focus on older persons who are vulnerable to cancer as contrasted with those who are not (e.g., sibship studies)]
Harvey Jay Cohen, M.D., Duke University Medical Center Derek Raghavan, M.D., Ph.D., University of Southern California School of Medicine, Norris Comprehensive Cancer Center
William B. Ershler, M.D., Institute for Advanced Studies in Aging and Geriatric Medicine, Washington, D.C.
The NIA/NCI workshop goal and outcome in research priority specification is an important step forward in the research planning and program development for the aging/cancer research interface. Creative ideas stemming from this workshop, which included scientists from diverse disciplines and professions, have the potential to produce groundbreaking research programs that facilitate collaborative studies to integrate aging and cancer research. The NCI-designated cancer centers are crucial in expanding the knowledge base on cancer in older persons. The cancer center workshop priorities encourage scientific productivity in critical areas on behalf of our nation's older citizens.
A combination of expertise and rich ideas has produced the foundation for a research agenda directed at the complex interface of aging and cancer. The full report of the NIA/NCI workshop is organized into five sections:
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