Cancer in nonagenarians: profile, treatments and outcomes

Objective: An increasing number of nonagenarians are treated for cancer. However, very few data are available to guide treatment choices in this often frail population. Materials and methods: The charts of all patients registered at Moffitt Cancer Center between 1993 and 2006 who were aged 90 or older at the time of treatment/evaluation were reviewed, and those treated for an active cancer (n=177) were included in the analysis. Results: For 23.5% of patients, the index cancer was a second malignancy. Initial treatments were surgery, 41%; chemotherapy, 9%; radiation therapy, 15%; concomitant chemoradiation therapy, 2%; hormonal therapy, 12%; targeted therapy, 8%; photodynamic therapy, 1%; observation/supportive care, 3%; hospice, 9%. The median survival was 1.69 years [95% CI=1.34, 2.17, range 0.1-6.21]. For early stage cancer, it was 2.02 years [95% CI = 1.56, 2.87], and for advanced stage cancer, 1.06 years. [95% CI=0.58, 1.63] (p=0.02 by log-rank). Treatment related mortality was low (1.1%). Conclusions: In conclusion, our nonagenarians underwent a broad range of treatments with low treatment-related mortality. Advanced cancer still limits the survival of nonagenarians. Second cancers are frequent in older cancer survivors. (C) 2010 Elsevier Ltd. All rights reserved.