Contemporary improvements in early detection and diagnosis, cancer treatment, and the implementation of population-based cancer prevention and control strategies have contributed to a sustained decline in overall cancer mortality rates. Although this trend is promising, challenges at the nexus of cancer and aging are, in turn, becoming more prominent. Older adults (age 65 years and older) are the largest growing segment of the U.S. population, and aging into older adulthood is associated disproportionally with the incidence of common cancers. As survival rates for some pediatric, adolescent and young adult (AYA), and common adult-onset cancers improve, the number of cancer survivors, particularly among older adults, and the number living with treatment-related consequences will continue to increase. Emerging evidence suggests some cancers and cancer treatments change the hallmarks of aging, shift aging trajectories, influence aging-associated outcomes like gait speed, frailty, and functional independence, and increase risks for multimorbidity and subsequent malignancies.
This shifting survivorship landscape has profound implications for cancer care delivery, coordination and transitions, and the cancer research enterprise. Despite the relationship between advancing age and cancer risk, older adults are underrepresented in observational and intervention cancer prevention and control studies, relative to other age groups. There are opportunities to expand eligibility criteria, design intervention studies explicitly for older adults, and include - as scientifically justified - aging biomarkers, assessments (e.g., geriatric assessment), and endpoints relevant to the inherent heterogeneity in biologic, phenotypic, and functional aging. Moreover, even along the pre-clinical to translational research continuum, opportunities exist for the development and use of age/aging-relevant and clinically informative animal models of human cancers and treatment-related late effects.
The NCI Annual Plan & Budget Proposal for Fiscal Year 2020 highlighted the need to increase understanding of the role of aging in cancer. The convergence of demographic, epidemiologic, and societal trends makes primary through quarternary cancer prevention during older adulthood a public health imperative. A lifespan approach to the elimination or reduction of cancer risk associated with obesity, tobacco use, and physical inactivity is critical for the primary prevention of cancers and other chronic conditions that contribute substantial public health burden during mid-life and older adulthood. Surveillance methods are needed to track aging-relevant factors associated with cancer burden (e.g., multiple chronic conditions, polypharmacy, short- and long-term adverse effects, financial toxicity, residential stability, and institutional care transitions - such as nursing homes, hospice - and behavioral and social exposures). As pediatric and AYA cancer survivors age chronologically and biologically and experience adverse physical, psychosocial, and behavioral outcomes, interventions to prevent, ameliorate or rehabilitate aging-related consequences of cancer and its treatments are a priority. Strategic investments in aging research will contribute to population health by preserving or promoting healthspan and ensuring equitable access to and benefit from advances in cancer prevention, control, and population science.
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|Cancer Center||Address||Cancer and Aging|
|The Jackson Laboratory||600 Main Street, Bar Harbor, ME 04609|
|Oregon Health & Science University Knight Cancer Institute||3181 S.W. Sam Jackson Park Road, Portland, OR 97239|
|Robert H. Lurie Comprehensive Cancer Center of Northwestern University||303 E. Superior St. Chicago, IL 60611|
|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins||401 North Broadway, Baltimore, MD 21231|
|Stephenson Cancer Center at The University of Oklahoma||800 NE 10th Street, Oklahoma City, Oklahoma 73104|
|University of Colorado Cancer Center||13001 E. 17th Place, Aurora, CO 80045|
|University of Michigan Rogel Cancer Center||1500 E. Medical Center Drive, Ann Arbor, MI 48109|
|University of Southern California, Norris Comprehensive Cancer Center||1441 Eastlake Ave., Los Angeles, CA 90089|