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Original article
Cancer in the elderly in the Czech Republic J. PETERA, MD, PHD, PROFESSOR, Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Kralove, L. DUŠEK, RNDR, PHD, ASSOCIATE PROFESSOR, Institute of Biostatistics and Analyses, Masaryk University, Brno, I. SIRÁK, MD, PHD, PHYSICIAN, Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, R. SOUMAROVA, MD, PHD, ASSOCIATE PROFESSOR, Department of Radiotherapy and Oncology, Mendel Cancer Centre, Nový Jicˇín, & J. JARKOVSKY, MSC, PHD, STATISTICIAN, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic PETERA J., DUŠEK L., SIRÁK I., SOUMAROVA R. & JARKOVSKY J. (2015) European Journal of Cancer Care 24, 163–178 Cancer in the elderly in the Czech Republic Population ageing presents a challenge to oncological care due to the particularities of cancer treatment in this population. We evaluate cancer epidemiology, treatment and survival, in the Czech Republic by age groups. Data published by the Czech National Cancer Registry from the years 2006 to 2010 were used for this study. The following cancer types were evaluated: colorectal, pancreatic, head and neck, lung, skin melanoma, breast, gynaecological, prostate, kidney and stomach cancers. The following data were recorded and analysed: crude incidence by 5-year age group; dynamics of crude incidence rates in the age group ≥70 years; disease stage; percentage of patients treated by surgery, radiotherapy and chemotherapy; and age standardised 1-year mortality and 5-year relative survival according to age group. Patients over age 70 accounted for 41% and 46%, respectively, of the cancer incidence and mortality of the whole population. Anticancer therapies are significantly less common in patients over age 70 (P < 0.050), with the exception of skin melanoma. Survival was markedly worse in older patients (P < 0.050) when radical treatment modalities were significantly underused (P < 0.050). In the Czech Republic, the crude cancer incidence in seniors is increasing. In general, elderly patients are undertreated, with worse treatment results compared with younger patients.
Keywords: older person, cancer, therapy, oncological outcome.
INTRODUCTION The population in developed countries is ageing and, consequently, the proportion of the population considered elderly is also increasing. In 1970, 7% of the population in the Czech Republic was over 70 years of age; by 2009, that figure had risen to 10% and is expected to reach 25% by the year 2030 (Czech Statistical Office 2010). One direct
Correspondence address: Jirˇí Petera, Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic (e-mail: [email protected]).
Accepted 26 December 2014 DOI: 10.1111/ecc.12287 European Journal of Cancer Care, 2015, 24, 163–178
© 2015 John Wiley & Sons Ltd
consequence of an ageing population is an increase in the crude incidence rate of cancer. This increased risk of cancer with age may be explained by DNA damage that accrues over time as a result of cumulative exposure to cancerogenic factors and a progressive decline in host defences against tumour growth (Tesarova 2013). The growing incidence and mortality of malignant disease in elderly patients presents a new challenge to daily oncological practice due to the particularities of cancer care in this population. Given this background, the aim of the present study was to evaluate cancer epidemiology in the Czech Republic from the years 2006 to 2010 and to assess differences in treatment and outcomes between elderly and non-elderly patients.
PETERA ET AL.
MATERIALS AND METHODS Data published by the Czech National Cancer Registry (CNCR) were used for this study. The CNCR has been maintained since the registry was first instituted in 1977 as a national database covering 100% of cancer diagnoses and the entire Czech population. The most recent validated outcomes are from 2010 and the CNCR database contains more than 1.8 million records. Registration of malignant neoplasms is stipulated by legislation and, therefore, obligatory. The CNCR is a part of the National Health Information System and is administered by the Institute of Health Information and Statistics of the Czech Republic (Pavlík et al. 2014). The CNCR is considered a key database component of the Czech National Cancer Control Programme, which was created to report regular and timely estimates of the cancer burden in the Czech population. Malignant neoplasms are recorded according to the International Classification of Diseases for Oncology, 10th revision (World Health Organisation 1992). Tumour staging is based on the TNM classification system (Sobin & Wittekind 2002). Standardised death certificates, based on international guidelines published by the World Health Organisation, are used in the Czech Republic to record precise data on the cause of death in each individual. Generally, it is the general practitioner who issues the death certificate. The causes of death are classified according to the International Classification of Diseases-10, which provides standardised nomenclature in this field. This system ensures the comparability of official Czech mortality data with common international reporting.
100 000 population (crude incidence) were calculated by gender and age groups and corrected to account for the country’s population age structure (Czech Statistical Office 2010). The recent CNCR data from the period of 2006–2010 were used for the analyses. The elderly population was defined as age ≥70 years. The following cancer types and locations were evaluated: colorectal cancer (CRC), pancreatic cancer, head and neck tumours, lung cancer, skin melanoma, breast and gynaecological cancers, prostate, kidney and stomach cancer. The following parameters were collected and analysed: crude incidence by 5-year age groups; dynamics of crude incidence rate in the elderly (≥70 years); disease stage; percentage of patients treated by surgery, radiotherapy and cytotoxic chemotherapy; overall 1-year ASR mortality; and overall relative 5-year ASR survival by age ≥70 and 65 years of age. As Figure 2 shows, the crude incidence rate for all common tumours, except for stomach cancer, has increased in recent years in the >70 year age group. In these common tumour types, patients ≥70 years accounted for 41% and 46%, respectively, of the incidence and mortality of the whole population (Table 1). Table 2 provides an overview of the treatment used for primary cancers by age group (
Original article
Cancer in the elderly in the Czech Republic J. PETERA, MD, PHD, PROFESSOR, Department of Oncology and Radiotherapy, University Hospital and Medical Faculty, Hradec Kralove, L. DUŠEK, RNDR, PHD, ASSOCIATE PROFESSOR, Institute of Biostatistics and Analyses, Masaryk University, Brno, I. SIRÁK, MD, PHD, PHYSICIAN, Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, R. SOUMAROVA, MD, PHD, ASSOCIATE PROFESSOR, Department of Radiotherapy and Oncology, Mendel Cancer Centre, Nový Jicˇín, & J. JARKOVSKY, MSC, PHD, STATISTICIAN, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic PETERA J., DUŠEK L., SIRÁK I., SOUMAROVA R. & JARKOVSKY J. (2015) European Journal of Cancer Care 24, 163–178 Cancer in the elderly in the Czech Republic Population ageing presents a challenge to oncological care due to the particularities of cancer treatment in this population. We evaluate cancer epidemiology, treatment and survival, in the Czech Republic by age groups. Data published by the Czech National Cancer Registry from the years 2006 to 2010 were used for this study. The following cancer types were evaluated: colorectal, pancreatic, head and neck, lung, skin melanoma, breast, gynaecological, prostate, kidney and stomach cancers. The following data were recorded and analysed: crude incidence by 5-year age group; dynamics of crude incidence rates in the age group ≥70 years; disease stage; percentage of patients treated by surgery, radiotherapy and chemotherapy; and age standardised 1-year mortality and 5-year relative survival according to age group. Patients over age 70 accounted for 41% and 46%, respectively, of the cancer incidence and mortality of the whole population. Anticancer therapies are significantly less common in patients over age 70 (P < 0.050), with the exception of skin melanoma. Survival was markedly worse in older patients (P < 0.050) when radical treatment modalities were significantly underused (P < 0.050). In the Czech Republic, the crude cancer incidence in seniors is increasing. In general, elderly patients are undertreated, with worse treatment results compared with younger patients.
Keywords: older person, cancer, therapy, oncological outcome.
INTRODUCTION The population in developed countries is ageing and, consequently, the proportion of the population considered elderly is also increasing. In 1970, 7% of the population in the Czech Republic was over 70 years of age; by 2009, that figure had risen to 10% and is expected to reach 25% by the year 2030 (Czech Statistical Office 2010). One direct
Correspondence address: Jirˇí Petera, Department of Oncology and Radiotherapy, University Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic (e-mail: [email protected]).
Accepted 26 December 2014 DOI: 10.1111/ecc.12287 European Journal of Cancer Care, 2015, 24, 163–178
© 2015 John Wiley & Sons Ltd
consequence of an ageing population is an increase in the crude incidence rate of cancer. This increased risk of cancer with age may be explained by DNA damage that accrues over time as a result of cumulative exposure to cancerogenic factors and a progressive decline in host defences against tumour growth (Tesarova 2013). The growing incidence and mortality of malignant disease in elderly patients presents a new challenge to daily oncological practice due to the particularities of cancer care in this population. Given this background, the aim of the present study was to evaluate cancer epidemiology in the Czech Republic from the years 2006 to 2010 and to assess differences in treatment and outcomes between elderly and non-elderly patients.
PETERA ET AL.
MATERIALS AND METHODS Data published by the Czech National Cancer Registry (CNCR) were used for this study. The CNCR has been maintained since the registry was first instituted in 1977 as a national database covering 100% of cancer diagnoses and the entire Czech population. The most recent validated outcomes are from 2010 and the CNCR database contains more than 1.8 million records. Registration of malignant neoplasms is stipulated by legislation and, therefore, obligatory. The CNCR is a part of the National Health Information System and is administered by the Institute of Health Information and Statistics of the Czech Republic (Pavlík et al. 2014). The CNCR is considered a key database component of the Czech National Cancer Control Programme, which was created to report regular and timely estimates of the cancer burden in the Czech population. Malignant neoplasms are recorded according to the International Classification of Diseases for Oncology, 10th revision (World Health Organisation 1992). Tumour staging is based on the TNM classification system (Sobin & Wittekind 2002). Standardised death certificates, based on international guidelines published by the World Health Organisation, are used in the Czech Republic to record precise data on the cause of death in each individual. Generally, it is the general practitioner who issues the death certificate. The causes of death are classified according to the International Classification of Diseases-10, which provides standardised nomenclature in this field. This system ensures the comparability of official Czech mortality data with common international reporting.
100 000 population (crude incidence) were calculated by gender and age groups and corrected to account for the country’s population age structure (Czech Statistical Office 2010). The recent CNCR data from the period of 2006–2010 were used for the analyses. The elderly population was defined as age ≥70 years. The following cancer types and locations were evaluated: colorectal cancer (CRC), pancreatic cancer, head and neck tumours, lung cancer, skin melanoma, breast and gynaecological cancers, prostate, kidney and stomach cancer. The following parameters were collected and analysed: crude incidence by 5-year age groups; dynamics of crude incidence rate in the elderly (≥70 years); disease stage; percentage of patients treated by surgery, radiotherapy and cytotoxic chemotherapy; overall 1-year ASR mortality; and overall relative 5-year ASR survival by age ≥70 and 65 years of age. As Figure 2 shows, the crude incidence rate for all common tumours, except for stomach cancer, has increased in recent years in the >70 year age group. In these common tumour types, patients ≥70 years accounted for 41% and 46%, respectively, of the incidence and mortality of the whole population (Table 1). Table 2 provides an overview of the treatment used for primary cancers by age group (
