Dramatic Growth in Cancer Rates Among the Elderly and Minorities
Cancer Newsline Audio Podcast Series
Date: May 04, 2009
Duration: 0 / 16:27
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Dr. David Wetter:
to Cancer News Line, a weekly podcast series from the
Dr. Ben Smith:
several years, my primary area of research focus has been studying optimal
radiation therapy treatments, particularly for older women with breast cancer.
And as I would go to write various manuscripts on this topic, I always wanted
to include something in my introductions or discussions regarding how many new
breast cancer diagnoses we could anticipate in the future as the United States
population ages. And to my surprise I could never find a good reference that
could actually explain to me how the changing demographics of the
Dr. Smith, can you walk our listeners through how you went about doing the research?
be happy to. We obtained population projections from the United States Census
Bureau through 2030 and we also calculated current cancer incidence rates using
a data from the SEER Registry which is a population based cancer registry
maintained by the National Cancer Institute and comprises approximately 26
percent of the
Can you tell us about what your key findings were?
primary key finding is that as our population changes and becomes more diverse
and also older, the number of cancers will increase
substantially. Between 2010 and 2030 the
Interesting… In the study you note that these findings underscore the growing need for inclusive clinical trials. For so long, both populations have been under represented in therapeutic trials. Can you tell us a little bit about that?
Yeah so it's remarkable. In 2010, our data suggests that approximately 60 percent of cancers will be diagnosed in individuals 65 and older. And also in 2010, about 21 percent of cancers will be diagnosed in nonwhite minorities. So already, the majority of cancers are diagnosed in older adults and yet in the studies that have been done in the 1990s and 2000s, for large clinical trials many times the older individuals and minorities are profoundly under represented in these studies. So that I think is alarming that our fastest growing segment of our population and the most common segment of the population to have cancer older adults - have been so profoundly under represented. And in the past many clinical trials would have an age exclusion criteria so that if you were 71 you couldn't enroll in a trial because the trial only enrolled individuals up to the age of 70. And I think there's been growing awareness in the field of clinical oncology that that's a problem and so there are efforts underway to design clinical trials specifically targeting older individuals. And there's also been a great deal of interest on the part of the National Cancer Institute to stimulate enrollment of minority individuals in clinical trials. And I think Dr. Wetter you may know better than I, but I think that we're starting to just see a little bit of the fruits of those efforts and I certainly hope they will continue.
Thank you. I would think that effort would need to go hand in hand with making clinical trials and cancer treatment more cost effective.
Well certainly, I completely agree with that. There is a very interesting study that was just published in the Journal of the National Cancer Institute last year. And they used data from Medicare records to quantify how cancer costs have increased between 1991 and 2002. And they found that for common cancers the cost of treating a person with cancer to Medicare increased by about 15 to 20 percent during that time period, even after adjusting for inflation. So we have clear documentation that the cost of treating an individual cancer patient has increased and the total number of people diagnosed with cancer is going to increase substantially. And so we have 2 independent factors which are going to synergistically and remarkably increase the cost of cancer care over the next 20 years. And in my opinion, this increase in cost is going to be unsustainable and so I think that we really need to rethink some of the areas of focus in clinical oncology research and in clinical trial design to support the development of cost effective therapies. It's interesting, I'm a Radiation Oncologist and most of the new research that's presented in radiation oncology is focused towards using newer technologies which happen to be tremendously expensive: technologies like intensity modulated radiotherapy, stereotactic radio surgery, proton beam radiotherapy. And all of these technologies have potential advantages. They may be theoretical or they may have been proven in studies already, but they also carry a tremendous cost. And I think we really need to rethink the focus of our research rather than solely driving -- having technology drive the focus of our research. I think the focus of our research really needs to be in how do we deliver care to patients that's cost effective and achieves the results that we need without imposing more and more of a burden on the healthcare system?
Can you tell us a little bit about the role of prevention such as screening, chemo prevention, smoking cessation and things like that?
well obviously the best way to deal with cancer is to prevent it from
occurring. And we assume that the risk of developing cancer for any individual
will remain constant over time, but -- and if that risk remains constant as our
population grows and changes, the number of cancers will increase
substantially. But what would be ideal is if that risk of cancer per person
would decrease over time and that will help to soften the blow of the changes
This is really a societal issue that will impact us all. Let's talk about how these increases in cancer cases will stress our healthcare system.
that's a very interesting question. Between 2010 and 2030, our paper projects
that the number of cancers diagnosed in the
Are there organizations and initiatives that are beginning to tackle some of those issues?
Well there are. As I mentioned the American Association for Medical Colleges has been very active in raising awareness of this issue, in lobbying Congress to support efforts to increase the capacity of the healthcare system and in supporting an increase in medical school enrollment across the country. The American Society of Clinical Oncology has also been very active. They have established a workforce committee on -- they have completed their own projections for the anticipated shortfall in hematologists oncologists and they're working with hematology oncology fellowship programs to increase the number of trainees and also help to teach their trainees how to practice in an environment that has scarce resources. And one thing that I found encouraging is that between 2002 and 2007 the total number of fellowship or residency for both hematology oncology and radiation oncology have increased by 30 percent. So we do see that there are increased physicians that are being trained for these cancer fields. And finally, anyone who's read the newspaper recently is well aware that there's a renewed interest on the part of the federal government of confronting the issue of the rising costs of healthcare and in trying to develop novel strategies to help counterbalance that and help bring healthcare costs under better control as we look to the future and anticipate an increase in demand for healthcare services.
Thank you so much Dr. Smith for talking with us today about your study. These are significant findings that certainly need to be addressed at every level of the healthcare system.
You're welcome. It was a pleasure participating in this podcast. Thank you very much Dr. Wetter.
Take care. If you have questions about anything you've heard today on Cancer News Line, contact Ask M.D. Anderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer News Line. Tune in next week for the next podcast in our series.
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