Management of cancer in the elderly: therapeutic dilemmas.

As the average life span has increased, the number of elderly patients with cancer has increased. One of the greatest dilemmas in the management of cancer in the elderly is the fact that often regular curative treatment cannot be executed. From this viewpoint, 679 patients with head and neck cancer treated during a recent 5-year period were reviewed. They were classified into two age groups: those younger than 75 years (n = 560) and those 75 years and older (n = 119). The frequency with which curative treatment could not be executed was 8.8% in the younger group and 26.1% in the older group. The major reasons were concomitant health problems and failure to obtain the patient's consent, and these problems were significantly more common in the older group. The incidence of asthma, pulmonary emphysema, cardiac failure, hypertension, arrhythmia, cerebrovascular disease, and kidney failure was greater in the older group. The overall 3-year survival rate was 18% in the cases with no curative treatment and 77% in those curatively treated.