**3. The aging population**

Population age is increasing in developed country. In the United States, in 2000, there were 35 million persons aged over 65 years old. This proportion is expected to continue to increase from 40 million in 2010 to 81 million in 2040 (U.S. Census Bureau). In Canada, the situation is similar. In 2036, Statistics Canada estimates the population of persons aged 70 years and older to be situated between 10 and 10.8 million.

Lung Cancer in Elderly 227

In Canada, both in men and women, lung cancer is the second most common cancer (13.9%) after prostate cancer in men and breast cancer in women. In 2010, it represents 24,200 new cases. More than half of all newly diagnosed cases will occur among people aged 70 years and older. More importantly, lung cancer is the leading cause of cancer death in both sex representing 20,600 deaths. Lung cancer deaths peak at age 70-79 years for both male and

In United States, median age for diagnosis for lung cancer was 71 years of age from 2004 to 2008 according to SEER data. 29% of cases were in persons aged between 75 and 84 and 8.3% were older than 85 years old. In the same period, the median age at death for cancer of the lung and bronchus was 72 years of age, with 30.7% between ages 75 and 84 and 9.6% in

On the oncologic point of view, evaluation of an elderly patient should be exactly the same as for a younger one. Clinical and pathological stage of disease should be determined with the same accuracy. The complete workup for lung cancer includes at least a complete history and physical examination, a bronchoscopy, a CT scan of the chest and upper abdomen and blood tests for assessment of liver and renal function. CT scan of the head should be done if there are any suspicions of metastasis, or in advanced cases, as well as a complete bone scan. Ideally, patients must have a Pet-Scan to complete the workup. As for

When surgery or radiation therapy treatment are anticipate, pulmonary function test are

Unfortunately, in the elderly population, lung cancers are less susceptible to be diagnosed at an early stage and the evaluation is more often incomplete. More than 20% of cancers in patients aged more than 85 years of age are diagnosed on a clinical or radiologic basis

The geriatric assessment of a patient is also a diagnostic process. It may be done by an individual clinician, but more often, the geriatric evaluation involve a more intensive multidisplinary program. This is often referred to a comprehensive geriatric assessment (CGA). The optimal goal is to evaluate the patients' global and functional status, in order to improve treatment decisions and outcomes. His use is now recommended by the International Society of Geriatric Oncology (SIOG) for all cancer patient aged more than 70 years old. This recommendation is based on the evidence that the incidence of geriatric problems increases sharply after 70 in cancer patients (Extermann et al., 2005, as cited in Balducci et al., 1990). The CGA permits to detect unaddressed problems, improve older cancer patients functional status and possibly their survival. The SIOG was not able to recommend any specific tool or approach above others for this assessment (Extermann et al.,

Whatever the approach or the tools used to complete a CGA, different aspects should be included as; functional status, comorbid medical conditions, cognitive and nutritional

status, psychological state, social support and review of the medication.

younger patients, biopsy of the tumour for histology is always mandatory.

essential to determine the capacity of the patient to tolerate those procedure.

without pathologic confirmation (Goddwin & Osborne, 2004).

**5. Lung cancer in elderly** 

persons older than 85 years.

**6.1 Oncologic evaluation** 

**6.2 Geriatric evaluation** 

2005).

**6. Evaluation of the elderly cancer patient** 

female in Canada.

The National institute of Aging has characterised the aging of the American Society as a "silver tsunami for which we are unprepared" (Fried & Hall, 2008).

#### **4. Cancer as an aging problem**

numbers of new cases from cancer.

Is is recognized that the risk of cancer increases with age. In Canada, 43% of all new cancer cases and 61% of cancer deaths will occur among those who are at least 70 years old. Figure 1 represents the number of new cases of cancer for Canadian males together with the corresponding age-standardized rates for 1981-2006 and estimates to the year 2010. It shows that despite the relative stability in age-standardized rates, the number of new cancer cases continue to rise steadily as the Canadian population grows and ages. The figure shows the major contribution of the population's growth and the aging population to the rising

Fig. 1. Incidence of cancer for Canadian males with age-standardized rates (1981-2006) (from Canadian Cancer Statistics 2010).

The lowest line represents the total number of new cancer cases that would have occurred each year if the population size and age structure had remained in the same as it was in 1981, reflecting the impact of changing risk. The middle line represents the number of new cases that would have occurred if the age structure had remained the same as it was in 1981, reflecting the impact of changing risk and population growth. The top line, the actually occurring number of new cancer cases, represents the combined impact of changes in risk, population growth and the aging of population. This figure is similar for new cancer cases ial of adjuvant chemotherapaths rates in male and female. It indicates the importance of the impact of the aging population on the growth in the number of cancer cases that has occurred over the last 30 years (Canadian Cancer Statistics 2010).

The National institute of Aging has characterised the aging of the American Society as a

Is is recognized that the risk of cancer increases with age. In Canada, 43% of all new cancer

Figure 1 represents the number of new cases of cancer for Canadian males together with the corresponding age-standardized rates for 1981-2006 and estimates to the year 2010. It shows that despite the relative stability in age-standardized rates, the number of new cancer cases continue to rise steadily as the Canadian population grows and ages. The figure shows the major contribution of the population's growth and the aging population to the rising

Fig. 1. Incidence of cancer for Canadian males with age-standardized rates (1981-2006) (from

The lowest line represents the total number of new cancer cases that would have occurred each year if the population size and age structure had remained in the same as it was in 1981, reflecting the impact of changing risk. The middle line represents the number of new cases that would have occurred if the age structure had remained the same as it was in 1981, reflecting the impact of changing risk and population growth. The top line, the actually occurring number of new cancer cases, represents the combined impact of changes in risk, population growth and the aging of population. This figure is similar for new cancer cases ial of adjuvant chemotherapaths rates in male and female. It indicates the importance of the impact of the aging population on the growth in the number of cancer cases that has

occurred over the last 30 years (Canadian Cancer Statistics 2010).

cases and 61% of cancer deaths will occur among those who are at least 70 years old.

"silver tsunami for which we are unprepared" (Fried & Hall, 2008).

**4. Cancer as an aging problem** 

numbers of new cases from cancer.

Canadian Cancer Statistics 2010).
