The incidence of cancer is increasing rapidly in Denmark as in most parts of the world, the main reason being the increasing longevity of the population, the so called demographic effect. In
Denmark, the annual number of new cancers is expected to increase from about 38,000 in 2015 to over 45,000 in 2030, almost 70% being over 65 years at diagnosis. Elderly cancer patients constitute an inhomogeneous group, some being fit and some frail, mostly due to varying degrees of comorbidity. In general, there is still lack of knowledge about treatment of older cancer patients and lack of national as well as international consensus on guidelines for their treatment.
Aim of AgeCareTo optimize cancer therapy and supportive care in older cancer patients.
Scientific Content of AgeCare • Epidemiological and biodemographic research in elderly focusing cancer and aging.Biological assessment of older patients including pharmacokinetics and pharmacodynamics • Identification of biomarkers associated with altered disease-outcome in elderly patients. • Development of geriatric assessment tools to distinguish between elderly cancer patients who will and who will not benefit from treatment. • Performance of clinical trials assessing treatment benefits in older cancer patients. • Performance of clinical trials particularly addressing treatment benefits and limitations in older cancer patients with comorbidity. • Assessment and prevention of side and late effects in older cancer patients. • Development of specific upfront rehabilitation plans for older cancer patients. • Explore the need for specific supportive care interventions in older cancer patients.
WP1: Epidemiology and genetic epidemiology of cancer in the elderlyThis WP will include five major research lines. 1) Age-trajectory of mortality and cancer. 2) Comorbidity in elderly patients with lymphoid malignancies. 3) Hereditability of various cancer forms with a special focus on the age-dependency of the genetics influence. 4) Prenatal hormonal influence on late-life cancer forms and 5) Interaction between cancer risk and longevity.
WP2: Cancer biology and molecular biomarkers associated with altered disease and treatment-outcomes in elderly patientsIdentification of biological alterations associated with elderly patients, including differences in cancer stem cell biology. Identification of biomarkers associated with altered disease-outcome in patients with increased age, using a panel of global analysis including proteomics, next-generation sequencing, gene array and cellular and small animal bioimaging.
WP3: SurgeryFive surgical specialities will focus on new treatment modalities and outcomes. Five areas of research related to cancer in the elderly: 1) Minimal invasive surgery, fast track. 2) Robot surgery in different cancer forms. 3) Cryo-therapy for different tumours and the use of this modality in the palliative setting. 4) Imaging in elderly patients. 5) Preserving of kidney function.
WP4: RadiotherapyA number of trials will investigate 1) Risk of recurrence following curative intended radiotherapy in younger versus elderly cancer patients. 2) Radiotherapy-induced side effects in elderly cancer patients with one or more comorbid conditions. 3) The use of image-guided radiotherapy (IGRT) in elderly cancer patients who receive radiotherapy with a curative intent.
WP5: Medical cancer treatmentA number of phase I and II trials comprising different disease groups (lung, GI cancer, gynecologic, urologic, hematologic, breast and head and neck cancer) will be designed specifically for elderly cancer patients. These will investigate 1) Dose response of chemotherapy in elderly cancer patients. 2) Tolerability. 3) Outcome in elderly cancer patients based on subgroups of regional and national registries. 4) Pharmacokinetics and pharmacogenetics.
WP6: Personalized supportive care for older patients with cancerThis WP will use comprehensive geriatric assessment (CGA) and address comorbidity focusing 1) Mapping of comorbidity in elderly cancer patients in the Region of Southern Denmark. 2) Preoperative CGA and interventions if needed to decrease postoperative complications and mortality. 3) Pre-chemotherapeutic CGA and interventions if needed to improve outcome of first line treatment in elderly cancer patients. 4) Pre-chemotherapeutic CGA and the ability to predict outcomes in elderly cancer patients with recurrent disease. Further, identification of late adverse effects of particular relevance to older cancer patients, e.g. bone complications. A possible relationship between side effects and pharmacokinetics and pharmacogenetics will be investigated. Rehabilitation will be another focus area.