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Objective: We examine international incidence trends of lung, colorectal, prostate, and breast cancers, as well as all cancers combined excluding non-melanoma skin cancer (NMSC) in adults aged 50 and older, over a fifteen-year period using data from 113 high quality population-based cancer registries included in the Cancer in Five Continents (CI5) series and NORDCAN. Materials and methods: We calculated annual incidence rates between 1998 and 2012 for ages 50–64, 65–74, and 75+, by sex and both sexes combined. We estimated average annual percentage change (AAPC) in rates using quasi-Poisson regression models. Results: From 1998 to 2012, incidence trends for all cancers (excluding NMSC) have increased in most countries across all age groups, with the greatest increase observed in adults aged 75+ in Ecuador (AAPC = +3%). Colorectal cancer incidence rates increased in the majority of countries, across all age groups. Lung cancer rates among females have increased but decreased for males. Prostate cancer rates have sharply increased in men aged 50–64 with AAPC between 5% and 15% in 24 countries, while decreasing in the 75+ age group in 21 countries, by up to −7% in Bahrain. Female breast cancer rates have increased across all age groups in most countries, especially in the 65–74 age group and in Asia with AAPC increasing to 7% in the Republic of Korea. Conclusions: These findings assist with anticipating changing patterns and needs internationally. Due to the specific needs of older patients, it is urgent that cancer systems adapt to address their growing number.

Age-related differences in colon and rectal cancer survival have been observed, even after accounting for differences in background mortality. To determine to what extent stage, tumour site, or histology could contribute to these differences, we estimated 1-year relative survival (RS) age stratified by these factors. Colon and rectal cancer cases diagnosed between 2012 and 2016 and followed up until 2017 were retrieved from 18 United States Surveillance Epidemiology and End Results cancer registries. For colon cancer, 1-year RS ranged from 87.8% [95% Confidence Interval: 87.5-88.2] in the 50–64-year-old age group to 62.3% [61.3-63.3] in the 85–99-year-old age group and for rectal cancer ranged from 92.3% [91.8-82.7] to 65.0% [62.3-67.5]. With respect to stage, absolute differences in RS between 50–64-year-old and 75–84-year-old in RS increased with increasing stage (from 6 [5-7] %-points in localized disease to 27 [25-29] %-points in distant disease) and were the highest for cancers of unknown stage (>28%-points). With respect to topography, age-related differences in survival were smallest for those in right-sided colon (8 [7-9] %-points) and largest for tumours of the colon without topography further specified (25 [21-29] %-points). While age-related differences in survival varied by histology and tumour site, the overall age-related differences in survival could not be explained by differences in distribution of these factors by age, consistent with a hypothesis that stage at diagnosis or treatment are more likely drivers. Incorporating data on geriatric conditions such as frailty and comorbidity would support further understanding of the age gap in colon and rectal cancer survival.

Cancer survival has improved since the 1990s, but to different extents across age groups, with a disadvantage for older adults. We aimed to quantify age-related differences in relative survival (RS - one-year, and one-year conditioning on surviving one year) for 10 common cancer types by stage at diagnosis. We used data from 18 United States Surveillance Epidemiology and End Results cancer registries and included cancers diagnosed between 2012-2016 followed until December 31, 2017. We estimated absolute differences in RS between the 50-64 age group and the 75-84 age group. The smallest differences were observed for prostate and breast cancers (1.8%-points [95% confidence interval (CI):1.5-2.1] and 1.9%-points [95%CI:1.5-2.3], respectively). The largest was for ovarian cancer (27%-points, 95%CI:24-29). For other cancers, differences ranged between 7 (95%CI:5-9, esophagus) and 18%-points (95%CI: 17-19, pancreas). Except for pancreatic cancer, cancer type and stage combinations with very high (>95%) or very low (Novelty and ImpactIn this analysis of United States population-based cancer registry data, age-related differences in cancer survival varied widely, ranging from less than 1% absolute difference in localized breast and prostate cancer survival to over 30% absolute difference in localized pancreatic cancer survival. Focused efforts to reduce age-related differences in cancer survival may have greatest impact by prioritizing cancer site and stage combinations with the widest differences.

Background Avoiding “causal” language with observational study designs is common publication practice, often justified as being a more cautious approach to interpretation. Objectives We aimed to i) estimate the degree to which causality was implied by both the language linking exposures to outcomes and by action recommendations in the high-profile health literature, ii) examine disconnects between language and recommendations, iii) identify which linking phrases were most common, and iv) generate estimates by which these phrases imply causality. Methods We identified 18 of the most prominent general medical/public health/epidemiology journals, and searched and screened for articles published from 2010 to 2019 that investigated exposure/outcome pairs until we reached 65 non-RCT articles per journal (n=1,170). Two independent reviewers and an arbitrating reviewer rated the degree to which they believed causality had been implied by the language in abstracts based on written guidance. Reviewers then rated causal implications of linking words in isolation. For comparison, additional review was performed for full texts and for a secondary sample of RCTs. Results Reviewers rated the causal implication of the sentence and phrase linking the exposure and outcome as None (i.e., makes no causal implication) in 13.8%, Weak in 34.2%, Moderate in 33.2%, and Strong in 18.7% of abstracts. Reviewers identified an action recommendation in 34.2% of abstracts. Of these action recommendations, reviewers rated the causal implications as None in 5.3%, Weak in 19.0%, Moderate in 42.8% and Strong in 33.0% of cases. The implied causality of action recommendations was often higher than the implied causality of linking sentences (44.5%) or commensurate (40.3%), with 15.3% being weaker. The most common linking word root identified in abstracts was “associate” (n=535/1,170; 45.7%) (e.g. “association,” “associated,” etc). There were only 16 (1.4%) abstracts using “cause” in the linking or modifying phrases. Reviewer ratings for causal implications of word roots were highly heterogeneous, including those commonly considered non-causal. Discussion We found substantial disconnects between causal implications used to link an exposure to an outcome and the action implications made. This undercuts common assumptions about what words are often considered non-causal and that policing them eliminates causal implications. We recommend that instead of policing words, editors, researchers, and communicators should increase efforts at making research questions, as well as the potential of studies to answer them, more transparent. Summary box

The prediction of all-cause mortality is an important component of shared decision-making across the cancer care continuum, particularly in older adults with limited life expectancy, for whom there is an increased risk of over-diagnosis and treatment.Currently, several international societies recommend the use of all-cause mortality risk prediction tools when making decisions regarding screening and treatment in geriatric oncology. Here, we review some practical aspects of the utilization of those tools and dissect the characteristics of those most employed in geriatric oncology, highlighting both their advantages and their limitations.

Introduction: Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology. Materials and methods: We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis. Results: We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology. Discussion: Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings.

IntroductionSurvival from small cell lung cancer (SCLC) is poor and there has been little progress in treatment. There is little evidence on outcomes in patients aged 75+. We described patterns of chemotherapy use and outcomes using the national Systemic Anti-Cancer Treatment dataset in patients with stage III or IV SCLC in relation to age.MethodWe included 7,966 SCLC (67.6% stage IV) diagnosed between 2014-17 in England, treated with chemotherapy and followed up through 2017. Patterns of chemotherapy use, 30- and 90-mortality rates, 6-,12-month and median overall survival (OS) from the start of the first chemotherapy cycle were compared between those below and above the age of 75. OS was estimated using Kaplan Meier estimator and modeled using a flexible hazard regression model.ResultsOlder patients were 6-7 times less likely to receive curative treatment than younger patients regardless of stage. There were more frequent adjustments of treatment and dose reduction (stage III) in older than younger patients but no age-related differences in reduction of doses (stage IV), treatment delayed or stopped earlier than planned. Although 30-day mortality rates were similar across age groups in stage III SCLC (∼4%), older patients had higher early mortality and poorer OS than younger peers. In both stages, 6 and 12-month OS by age decreased around the age of 70-75 and were worse in patients with performance status scores ≥2.ConclusionThis study offers a snapshot of chemotherapy use and outcomes in advanced SCLC, notably in older patients, in the pre-immunotherapy era.

Background:Prostate cancer is an important cause of death worldwide. The number of years of life lost (YLL) due to prostate cancer is a metric of the toll of prostate cancer and using projections of demographic changes, can be used to measure future burden. Methods:Prostate cancer mortality data by country and world region was retrieved from the Global Cancer Observatory and the World Health Organization mortality data set, and life expectancy was from the United Nations Department of Economic and Social Affairs. We estimated YLL as the difference between age at death in people with prostate cancer and remaining life expectancy for people of the same age in the general population. We also estimated the age-standardized YLL rates per 100,000 males over 50 and the average annual percentage change in YLL rates over the period 2000–2019 and the number of YLL for the year 2040 by applying population projections to the 2020 YLL rates. Results:In 2020, 3.5 million person-years of life were lost due to prostate cancer in males over 50, and 40% of YLL were in those aged over 75. Age-standardized rates varied greatly between and within regions. Over the last two decades, rates of YLL have increased in many Asian and African countries while they have decreased in northern American and European countries. Globally, YLL are anticipated to double by 2040 to reach 7.5 million, with the greatest increases in Africa, Asia, and Latin America and the Caribbean. Conclusion:There are wide variations in the burden of prostate cancer globally as measured by YLL. The burden of prostate cancer is projected to increase over time and appears to be highest in Sub-Saharan Africa, Eastern Europe, and Latin America and the Caribbean. It will be critical to plan and implement programs to reduce the burden of prostate cancer globally.

BackgroundIn observational studies, the risk of immortal time bias (ITB) increases with the likelihood of early death, itself increasing with age. We investigated how age impacts the magnitude of ITB when estimating the effect of surgery on one-year overall survival (OS) in patients with stage IV colon cancer aged 50-74 and 75-99 in England.MethodUsing simulations, we compared estimates from a time-fixed exposure model to three methods addressing ITB: time-varying exposure, delayed entry, and landmark methods. We then estimated the effect of surgery on one-year OS using a national population-based cohort of patients derived from the CORECT-R resource.ResultsIn simulations, the magnitude of ITB was larger among older patients when their probability of early death increased or treatment was delayed. The bias was corrected using the methods addressing ITB. When applied to CORECT-R data, these methods yielded smaller effects than the time-fixed exposure approach but effects were similar in both age groups.ConclusionITB must be addressed in all longitudinal studies, particularly, when investigating the effect of an exposure on an outcome in different groups of people (e.g., age groups) with different distributions of exposure and outcomes.

An important aspect of the assessment of the health status of an older adult with cancer is estimating noncancer-specific survival, since this can be used to weigh the potential benefits and risks of treatment against the patient's all-cause mortality. Geriatric oncology guidelines issued by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend the use of validated tools to predict noncancer-specific survival, also labeled “life expectancy calculators”, in all patients aged 65 years and older before starting oncological treatment [1,2]. In addition, the estimation of noncancer-specific survival can also be integrated into the decision-making process for other medical interventions relevant for geriatric oncology, such as the decision of stopping screening in an older individual, or for determining the appropriateness of interventions related to the management of comorbidities in older adults with a cancer diagnosis. In this brief report, we outline some of the existing resources for estimating noncancer-specific survival and provide practical information as to how to use them in clinical practice.

BACKGROUND: A poor fat-soluble micronutrient (FMN) and a high oxidative stress status are associated with frailty. Our aim was to determine the cross-sectional association of FMNs and oxidative stress biomarkers [protein carbonyls (PrCarb) and 3-nitrotyrosine] with the frailty status in participants older than 65 years. METHODS: Plasma levels of vitamins A (retinol), D3 , E (alpha-tocopherol and gamma-tocopherol) and carotenoids (alpha-carotene and beta-carotene, lycopene, lutein/zeaxanthin, and beta-cryptoxanthin), PrCarb, and 3-nitrotyrosine were measured in 1450 individuals of the FRAILOMIC initiative. Participants were classified into robust, pre-frail, and frail using Fried's frailty criteria. Associations between biomarkers and frailty status were assessed by general linear and logistic regression models, both adjusted for cohort, season of blood sampling, gender, age, height, weight, and smoking. RESULTS: Robust participants had significantly higher vitamin D3 and lutein/zeaxanthin concentrations than pre-frail and frail subjects; had significantly higher gamma-tocopherol, alpha-carotene, beta-carotene, lycopene, and beta-cryptoxanthin concentrations than frail subjects, and had significantly lower PrCarb concentrations than frail participants in multivariate linear models. Frail subjects were more likely to be in the lowest than in the highest tertile for vitamin D3 (adjusted odds ratio: 2.15; 95% confidence interval: 1.42-3.26), alpha-tocopherol (2.12; 1.39-3.24), alpha-carotene (1.69; 1.00-2.88), beta-carotene (1.84; 1.13-2.99), lycopene (1.94; 1.24-3.05), lutein/zeaxanthin (3.60; 2.34-5.53), and beta-cryptoxanthin (3.02; 1.95-4.69) and were more likely to be in the highest than in the lowest tertile for PrCarb (2.86; 1.82-4.49) than robust subjects in multivariate regression models. CONCLUSIONS: Our study indicates that both low FMN and high PrCarb concentrations are associated with pre-frailty and frailty.

Introduction: This study aimed to investigate whether self-rated health (SRH) predict frailty and its components among community dwellers aged 75 years and older. Methods: We ran a cross-sectional and prospective analysis from 643 and 379 participants of the Bordeaux Center (France) of the Three-City Study, respectively. We assessed SRH using a single question with 5 response options. We defined frailty as having at least 3 out of the following 5 criteria: weight loss, exhaustion, slowness, weakness, and low energy expenditure. We used multivariate logistic regression and Cox proportional hazard models. Results: At baseline, poor SRH was significantly associated with frailty (odds ratio = 5.2; 95% confidence interval [CI]: 2.9–9.5) and its components except for weakness. In the prospective analysis on nonfrail participants, poor SRH was associated with the 4-year risk of slowness (hazard ratio [HR] = 1.7; 95% CI: 1.1–2.6) but not with that of frailty (HR = 1.6; 95% CI: 0.9–2.9) or the other components. Conclusions: In a French cohort of community dwellers aged 75 years or older, poorer SRH was associated with concomitant frailty and 70% higher risk of slowness over 4 years.

ObjectiveTo identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars.MethodsWe conducted a systematic review of literature published in EMBASE, MEDLINE, Scopus, and Web of Science according to PRISMA guidelines. We included population-based studies in patients with colon or lung cancer. We assessed the quality of included studies against selected evaluation domains from the QUIPS Tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between middle-aged group and the oldest age group, or by describing survival curves.ResultsOut of 2,162 references reviewed, we retained 35 studies (15 for colon, 18 for lung, 2 for both sites). Regardless of the cancer site, included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socio-economic status, stage at diagnosis, cancer site and morphology, the number of nodes examined, and by treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for females with lung cancer compared to males. Also, age disparities increased with more advanced stages for colon cancer, and decreased with more advanced stages for lung cancer.ConclusionsAlthough age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival. (PROSPERO registration number: CRD42020151402).Article SummaryStrengths and limitations of this studyFor the first time, we conducted a systematic review of population-based studies relating to differences in cancer survival between middle-aged and older patients, using colon and lung cancer as exemplar cancers.We limited our search to peer-reviewed original articles and letters to Editors published in English up until 30 September 2019.We excluded clinical studies and trials because of the strict selection of patients and the common underrepresentation of older patients in these studies.We could not conduct any quantitative analysis (such as meta-analysis) because of the vast heterogeneity of studies included, which prevented us from quantifying the relationship between increasing age and cancer survival.

We sought to understand the role of stage at diagnosis in observed age disparities in colon cancer survival among people aged 50 to 99 years using population-based cancer registry data from seven high-income countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom. We used colon cancer incidence data for the period 2010 to 2014. We estimated the 3-year net survival, as well as the 3-year net survival conditional on surviving at least 6 months and 1 year after diagnosis, by country and stage at diagnosis (categorised as localised, regional or distant) using flexible parametric excess hazard regression models. In all countries, increasing age was associated with lower net survival. For example, 3-year net survival (95% confidence interval) was 81% (80-82) for 50 to 64 year olds and 58% (56-60) for 85 to 99 year olds in Australia, and 74% (73-74) and 39% (39-40) in the United Kingdom, respectively. Those with distant stage colon cancer had the largest difference in colon cancer survival between the youngest and the oldest patients. Excess mortality for the oldest patients with localised or regional cancers was observed during the first 6 months after diagnosis. Older patients diagnosed with localised (and in some countries regional) stage colon cancer who survived 6 months after diagnosis experienced the same survival as their younger counterparts. Further studies examining other prognostic clinical factors such as comorbidities and treatment, and socioeconomic factors are warranted to gain further understanding of the age disparities in colon cancer survival.

Objective We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50–99 using New Zealand population-based cancer registry data linked to hospitalisation data. Method We included 21,270 new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to end 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on colon cancer survival by stage at diagnosis using flexible excess hazard regression models. Results The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first eighteen months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, emergency presentation for regional and distant cancers, and comorbidity for cancer with missing stages. Ethnicity and deprivation did not influence age disparities in colon cancer survival. Conclusion Factors reflecting timeliness of cancer diagnosis most affected age-related disparities in colon cancer survival, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.

ObjectiveWe described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalization data.DesignWe included new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to 31 December 2019. We linked these cases to hospitalisation data for the five years before the cancer diagnosis. We modelled the effect of age at diagnosis, sex, deprivation, comorbidity, and route to diagnosis on colon cancer survival by stage at diagnosis (localized, regional, distant, missing).ResultsNet survival decreased as the age at diagnosis increased, notably in advanced stages and missing stage. The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first 18 months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, the route to diagnosis for regional and distant cancers, and comorbidity for cancer with missing stages.ConclusionThe present population-based study shows that factors reflecting timeliness of cancer diagnosis most affected the difference in survival between middle-aged and older patients, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.

Objective To describe the cancer burden in adults aged 65 years and older in Latin America and the Caribbean to serve as rational for improving cancer control planning among region's older population. Materials and Methods Using the up-to-date GLOBOCAN estimates for 2018, we describe the cancer burden including key patterns for the major cancer sites among adults aged 65 years and older in Latin America and the Caribbean. We also predict the future burden in 2040 by applying population projections, assuming no changes in incidence rates over time. Results In 2018, an estimated 679,000 new cancer cases occurred among older adults in LAC, representing almost half (48%) of the total incidence burden (43% in Central America, 49% in South America, and 52% in the Caribbean). Prostate, colorectum, and lung were the most common cancers among older males in South America and the Caribbean, with non-melanoma skin cancer ranking third in Central America. Among older females, the most common sites were breast, colorectum, and non-melanoma skin cancer, except in the Caribbean, where lung cancer ranked third. Overall, the number of new cancer cases among older adults in the region is expected to double by 2040, reaching 1.6 million new cases. Conclusion Our findings highlight the need for an urgent adaptation of healthcare systems across LAC by improving training in geriatrics for the oncology workforce, and by including older adults in clinical guidelines, insurance schemes, and cancer prevention policies.

Using GLOBOCAN estimates, we describe the estimated cancer incidence among adults aged 80 years or older at the regional and global level in 2018, reporting the number of new cancer cases, and the truncated age‐standardised incidence rates (per 100 000) for all cancer sites combined for this age group. We also presented the five most frequent cancers diagnosed by region and globally among females and males aged 65 to 79 years old and 80 years or older. We, finally, estimated the number of new cancer cases in 2050, the proportion of cases aged 80 years or older, and the proportional increase between 2018 and 2050 by region, by applying population projections to the 2018 incidence rates. In 2018, an estimated 2.3 million new cancer cases (excluding nonmelanoma skin cancers) were aged 80 years or older worldwide (13% of all cancer cases), with large variation in the profiles at regional levels. Globally, breast, lung and colon were the most common cancer sites diagnosed in the oldest females, while prostate, lung and colon were most frequent in the oldest males. In 2050, an estimated 6.9 million new cancers will be diagnosed in adults aged 80 years or older worldwide (20.5% of all cancer cases). Due to the complexity of cancer management in the oldest patients, the expected increase will challenge healthcare systems worldwide, posing a tangible economic and social impact on families and society. It is time to consider the oldest population in cancer control policies., What's new? The global population of aging persons is expected to increase significantly over the coming decades. To prepare for the forthcoming challenges in cancer care, more information is needed on cancer burden among the world's oldest patients. Here, assessment of global cancer burden in adults in 2018 shows that 2.3 million new cases occurred in persons aged 80 or older that year, accounting for 13 percent of all cases worldwide. Projections suggest that by 2050, 7 million new cancer cases will affect this age group. The findings predict substantial challenges for healthcare and highlight the need for aging‐specific cancer control initiatives.

In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has affected millions of people in over 180 territories, causing a significant impact on healthcare systems globally. Older adults, as well as people living with cancer, appear to be particularly vulnerable to COVID-19 related morbidity and mortality, which means that older adults with cancer are an especially high-risk population. This has led to significant changes in the way geriatric oncologists provide care to older patients, including the implementation of novel methods for clinical visits, interruptions or delays in procedures, and modification of therapeutic strategies, both in the curative and palliative settings. In this manuscript, we provide a global overview of the perspectives of geriatric oncology providers from countries across Europe, America, and Asia, regarding the adaptive strategies utilized to continue providing high quality care for older patients with cancer during the COVID-19 pandemic. Through these perspectives, we attempt to show that, although each country and setting has specific issues, we all face similar challenges when providing care for our older patients with cancer during these difficult times.

Objectives Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population. Methods Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877). Results The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed: height (cm) = 72.75 + (1.86 × KHt [cm]) – (0.13 × age [y]) + 3.41 × sex (0: women; 1: men). This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula. Conclusion Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.

Population ageing has substantially contributed to the rising number of new cancer cases worldwide. We document cancer incidence patterns in 2012 among older adults globally, and examine the changing magnitude of cancer in this age group over the next decades. Using GLOBOCAN 2012 data, we presented the number and proportion of new cancer cases, and the truncated age-standardised incidence rates among adults aged 65 years and older for all cancer sites combined and for the five most common cancer sites by world region. We calculated the incidence in 2035 by applying population projections, assuming no changes in rates. In 2012, 6.7 million new cancer cases (47.5% of all cancers) were diagnosed among older adults worldwide, with marked regional disparities. Nearly 48% of these cases occurred in less developed regions. Lung, colorectal, prostate, stomach and breast cancers represented 55% of the global incidence, yet distinct regional patterns were observed. We predict 14 million new cancer cases by 2035, representing almost 60% of the global cancer incidence. The largest relative increase in incidence is predicted in the Middle East and Northern Africa (+157%), and in China (+155%). Less developed regions will see an increase of new cases by 144%, compared to 54% in more developed regions. The expected increase in cancer incidence at older ages will have substantial economic and social impacts globally, posing considerable and unique challenge to healthcare systems in every world region, especially in those with limited resources and weaker health systems.

The purpose of the study was to estimate the number of new breast cancer cases in France in 2015 attributable to breastfeeding for durations below recommendations (at least 6 months per child), and cases prevented through historical breastfeeding. As a secondary analysis, the corresponding numbers for ovarian cancer were estimated. Historical breastfeeding data were obtained from population surveys. Duration of breastfeeding data were obtained from the French Epifane cohort study. Relative risks were obtained from meta-analyses, cohort, and case–control studies. Cancer incidence data were obtained from the French Network of Cancer Registries. A 10-year latency period was assumed. Among parous women 25 years of age and older, 14.1% breastfed for at least 6 months per child born before 2006. As a result, 1,712 new breast cancer cases (3.2% of all new breast cancer cases) were attributable to breastfeeding for

Objectives To provide an overview on the role of family caregivers (FCGs) in the care of older adults with cancer and review quality of life needs for FCGs. Data Sources Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations were used. Conclusion The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults have a substantial impact on the quality of life of their FCGs. Practical and efficient models of comprehensive assessment, interventions, and caregiving preparedness support are needed to improve outcomes for both older adults with cancer and their FCGs. Implications for Nursing Practice Oncology nurses practicing in clinical and research settings have a responsibility to prepare themselves with evidence-based knowledge and resources to include the needs of FCGs in the care provided to older adults with cancer.

Summary Background Nutritional status among elderly people living in Sub-Saharan Africa is poorly studied, even though undernutrition and obesity are known to cause many complications and are risk factors for progression and death in several diseases. The aims of this study were to assess the nutritional status of the elderly in Central Africa and to study the factors associated with nutritional disorders (undernutrition and obesity). Methods Two cross-sectional population-based studies were carried out in the capitals of Central African Republic (CAR) and Republic of Congo (ROC) between 2008 and 2009. Participants were aged ≥65 years old and underwent nutritional assessment including the following measurements: weight, height, body mass index (BMI), waist circumference (WC). Diet was also investigated. Nutritional status was defined according to the WHO BMI classification ( Results 990 elderly people underwent nutritional assessment (482 in CAR and 508 in ROC). Mean BMI was 22.7 ± 4.8 kg/m2. The prevalence of undernutrition was 19.2% and was lower in ROC than in CAR (9.5% vs. 29.5%; p Conclusions The prevalence of undernutrition is high in the elderly population of these countries, in contrast to obesity. Undernutrition and obesity are associated with different socio-economic factors and food consumption. Simple nutritional advice could contribute to improving the nutritional status of elderly people in Central Africa.

We read with pleasure the study of Bolle and colleague titled “Medical decision making for older patients during multidisciplinary oncology team meetings” published in Journal of Geriatric Oncology in January 2019. We commented it in regards to the importance of decision-making in cancer management for older patients.

International audience; OBJECTIVE:We aimed at estimating the seroprevalence of Toxoplasma gondii infection in older adults living in Central Africa and investigating its association with dementia using data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) programme.METHODS:A cross-sectional multicentre population-based study was carried out among participants aged 73 (±7) years on average, living in rural and urban areas of the Central African Republic and the Republic of Congo between November 2011 and December 2012. Blood samples were collected from each consenting participant. The detection of anti-T.gondii immunoglobulin G antibodies was performed in 2014 in France using a commercially available ELISA kit. Participants were interviewed using a standardized questionnaire including sociodemographic characteristics. DSM-IV criteria were required for a diagnosis of dementia. Multivariate binary logistic regression models were used to estimate the association between toxoplasmosis infection and dementia.RESULTS:Among 1,662 participants, the seroprevalence of toxoplasmosis was 63.0% (95% confidence interval (CI): 60.7-65.3) overall, 66.6% (95%CI: 63.4-69.8) in Central African Republic and 59.4% (95%CI: 56.1-62.7) in the Republic of Congo. In multivariate analyses, toxoplasmosis status was significantly associated with increasing age (p=0.006), Republic of Congo (p=0.002), urban area (p=0.001) and previous occupation (p=0.002). No associations between dementia and toxoplasmosis status or anti- T.gondii IgG titres were found.CONCLUSION:T.gondii infection was not associated with dementia among older adults in Central Africa. Our findings are consistent with previous studies and add to the knowledge on the relationship between T.gondii infection and neurological disorders. This article is protected by copyright. All rights reserved.

Few studies have been interested in the relationship between dietary patterns and activity limitation in older adults yet. We analysed the association between dietary patterns and the risk of self-reported activity limitation – that is mobility restriction, limitation in instrumental activities in daily living (IADL) and in activities in daily living (ADL) – in community-dwellers aged 67+ years initially free of activity limitation in 2001–2002 and re-examined at least once over 10 years – that is 583 participants for mobility restriction, 1114 for IADL limitation and 1267 for ADL limitation. At baseline, five sex-specific dietary clusters were derived by hybrid clustering method from weekly frequency of intake of twenty food and beverage items. Self-reported mobility restriction, limitations in IADL and in ADL were assessed using the Rosow–Breslau, the Lawton–Brody and the Katz scales, respectively. Associations between dietary clusters and the risk of each activity limitation were assessed using Cox proportional hazard models. In models adjusted for socio-demographic and health-related covariates, compared with the ‘Healthy’ cluster the ‘Biscuits and snacking’ cluster was associated with a higher risk of mobility restriction (hazard ratio (HR)=3·0; 95 % CI 1·6, 5·8) and limitation in IADL (HR=2·1; 95 % CI 1·1, 4·2) in men and limitation in ADL in women (HR=2·3; 95 % CI 1·3, 4·0). In this French cohort of community-dwellers aged 67+ years, some unhealthy dietary patterns may increase the risk of activity limitation all along the disablement process in older adults.

Although the countries of Sub-Sharan Africa represent among the most rapidly growing and aging populations worldwide, no previous studies have examined the cancer patterns in older adults in the region as a means to inform cancer policies. Using data from Cancer Incidence in Five Continents, we describe recent patterns and trends in incidence rates for the major cancer sites in adults aged ≥60 years and in people aged 0-59 for comparison in four selected population-based cancer registries in Kenya (Nairobi), the Republic of South Africa (Eastern Cape Province), Uganda (Kyadondo country), and Zimbabwe (Harare blacks). Over the period 2008-2012, almost 9,000 new cancer cases were registered in older adults in the four populations, representing one-third of all cancer cases. Prostate and esophageal cancers were the leading cancer sites in older males, while breast, cervical and esophageal cancers were the most common among older females. Among younger people, Kaposi sarcoma and non-Hodgkin lymphoma were common. Over the past 20 years, incidence rates among older adults have increased in both sexes in Uganda and Zimbabwe while rates have stabilized among the younger age group. Among older adults, the largest rate increase was observed for breast cancer (estimated annual percentage change: 5% in each country) in females and for prostate cancer (6-7%) in males. Due to the specific needs of older adults, tailored considerations should be given to geriatric oncology when developing, funding and implementing national and regional cancer programmes.

Background: There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. Objectives: Our aim was to develop an adapted tool, the Central African – Daily Functioning Interference (DFI) scale. Methods: An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. Results: A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: –1.067 to 1.587) with good item discrimination properties (1.397–4.076) and a high reliability (Cronbach’s al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. Conclusions: These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly.

Introduction et but de l’etude Nous avons retrouve precedemment que la formule de Chumlea pour les noirs americains, validee pour la prediction de la taille a partir de la hauteur talon-genou (HTG), ne fournit une bonne prediction (± 5 cm) de la taille que dans 67 % des cas chez les personnes âgees (PA) d’Afrique Centrale (AC). Aucune formule n’est validee pour cette population. Le but de ce travail etait de creer et valider une formule predictive de la taille utilisant la HTG dans une population de PA d’AC. Materiel et methodes L’etude EPIDEMCA, a ete realisee chez des 1754 PA de plus de 65 ans au Congo et en Republique Centrafricaine. Les PA incluses ont beneficie d’une evaluation nutritionnelle avec mesure de la taille (cm) et de la HTG (cm). Les formules predictives ont ete creees a la suite d’une regression lineaire multiple selon le sexe, l’âge (ans) et la HTG a partir d’un sous-echantillon randomise (n = 877). La precision de cette nouvelle formule a ete testee sur l’autre moitie (n = 877). Des tests de correlation intraclasse et le pourcentage de bonne prediction ± 5 cm par rapport a la taille mesuree etaient calcules. Resultats et analyse statistique L’âge moyen etait de 72,9 ± 6,5 ans et la taille moyenne de 157,4 ± 9,2 cm. La sex-ratio H/F etait de 0,6 dans les deux pays. Une formule ajustee sur le sexe (FAS) a ete creee : taille (cm) = 72,75 + (1,86 × HTG)–(0,13 × âge) + 3,41 [si homme] ainsi que deux formules stratifiees sur le sexe (FSS), pour les hommes : taille (cm) = 82,77 + (1,76 × HTG)–(0,14 * âge [ans]) ; pour les femmes : taille (cm) = 74,09 + (1,78 × HTG)–(0,09 × âge). Le pourcentage de prediction et le coefficient de correlation intraclasse des deux formules dans la population test sont presentes dans le Tableau 1. Le pourcentage de bonne prediction ± 5 cm etait de 71,3 % et de 70,9 % pour les formules FAS et FSS, respectivement. Le pourcentage de bonne prediction etait significativement meilleur avec les formules FAS et FSS par rapport a la formule CPNA (p = 0,008 et p = 0,01, respectivement). L’indice de masse corporelle et le statut nutritionnel n’etaient significativement pas differents que ce soit en utilisant la taille mesuree ou les tailles predites (Tableau 1). Conclusion Les formules creees semblent applicables pour l’evaluation de la taille par la HTG chez les PA d’AC dans environ 71 % des cas. Ces formules pourront etre testees et validees dans d’autre pays d’Afrique pour l’estimation de la taille chez les PA afin d’etendre leur utilisation.

Given the ageing population worldwide and the consequent epidemiological transitions, dementia and related disorders are areas of increasing public health concern in developing countries. In sub-Saharan Africa, this issue is beginning to emerge. A literature review about epidemiology of dementia in these countries has been carried out. Few population-based studies conducted in Africa estimated prevalence from 2.3 % in Nigeria to 8.8 % in Central African Republic. However, the tests and criteria that were used are still not standardized. Further studies are needed to investigate possible diferences between urban and rural areas and the risk factors for dementia. Sub-Saharan Africa will soon face an important challenge for the management of these patients.

Several studies in Western countries have shown an association between cognitive disorders and low BMI or weight loss in elderly people. However, few data are available in Africa. We analysed the association between cognitive disorders and undernutrition among elderly people in Central Africa. A cross-sectional, multicentre, population-based study using a two-phase design was carried out in subjects aged 65 years and above in the Central African Republic (CAR) and the Republic of Congo (ROC). All subjects were interviewed using the Community Screening Interview for Dementia, and those with low performance were clinically assessed by a neurologist and underwent further psychometrical tests. Diagnostic and Statistical Manual-IV and Petersen's criteria were required for the diagnoses of dementia and mild cognitive impairment (MCI), respectively. Undernutrition was evaluated using mid-upper arm circumference (MUAC) 2 and arm muscular circumference (AMC) 2 (OR 2·3, 95 % CI 1·6, 3·1), AMC

International audience; Hypertension represents a major global health burden. While older individuals of African descent are at higher risk of hypertension in western countries, epidemiologic data on hypertension in older native Africans are scarce. We assessed the prevalence and the level of awareness and control of hypertension among older adults in Central Africa. A total of 1990 individuals aged 65 years and older from the Republic of Congo and the Central African Republic participated into a cross-sectional population-based survey. Hypertension was defined by self-reporting of ongoing treatment and/or systolic blood pressure/diastolic blood pressure at rest being ≥140 and/or 90 mm Hg. Controlled hypertension was defined as treated hypertension with systolic blood pressure

Introduction In 2012, about half of all new cancer diagnoses and deaths were estimated to occur among people age 65 years and older; these will be around two third by 2035. Assessing trends in cancer incidence and mortality in this growing population is of great importance to understand the impact of cancer on this vulnerable population and to design cancer control and management plans. We therefore described temporal trends in incidence and mortality for the most common cancers–i.e. breast, prostate, colorectal and lung cancers–in adults aged 65 years or older in 17 countries with long history of population-based cancer registration. Methods Data on incidence for cancers of the colorectum, breast, prostate and lung from 1983 to 2012 were obtained from the Cancer Incidence in Five Continents in17 countries in Asia, northern America, central and south America, northern Europe, western and southern Europe and Oceania. Cancer mortality data were obtained from the World Health Organization mortality database. Country- and sex-specific truncated age-standardized rates (65 + ) and average annual percentage changes were calculated. Results Between 1983 and 2012, incidence rates of colorectal cancer have increased between +0.4–22% on average annually in older males and between +0.0–15.7% in older females in most countries under study, while incidence rate has significantly decreased in USA (−8.3% in females and −10.6% in males). In contrast, mortality from colorectal cancer has decreased in all countries from −10.5% in Switzerland to −0.8% in Singapore but it has significantly increased in Costa Rica (+5.5% in males and 2.8% in females) and Spain (8.7% in males and +1.6% in females). The incidence of prostate and breast cancers has increased in almost all countries between 2.6% in Canada and +38.8% in Japan for prostate cancer and between +1.1% in USA and 19.4% in Japan for breast cancer. However, prostate and breast cancer mortality rates have decreased in most countries, except in Costa Rica (+4.5% and +3.3% for prostate and breast cancers respectively), Japan (+8.6% and +13.4%) and Singapore (+9.4% and +6.1%). In almost all countries, incidence and mortality rates for lung cancer have greatly increased in females over the 30-year period following the smoking epidemic pattern (from 5.2% and 0.7% respectively in Japan to 35.8% and 26.0%, respectively in Netherlands), while lung cancer in males are largely decreasing, notably in UK, Netherlands and Finland (> −10% per year on average for incidence and mortality rates). Conclusion Decreasing deaths from cancer in older adults might probably be related to earlier cancer detection and better management. Yet, the rising incidence of the most common cancer sites will increase strain in national health care resources and therefore prevention programs needs to be strengthen. The expected rise in the number of new older cancer patients must encourage the development of geriatric oncology worldwide.

Objective: To analyze the association between dietary patterns and the 12-year risk of frailty and its components in community-dwelling elderly French adults. Design: A prospective cohort study. Setting: The Bordeaux sample of the Three-City Study. Participants: A total of 972 initially nonfrail nondemented participants (336 men and 636 women) aged 73 years on average, re-examined at least once over 12 years. Measurements: Five sex-specific dietary clusters were previously derived at baseline. Frailty incident to the baseline visit was defined as having at least three out of the following 5 criteria: unintentional weight loss, exhaustion, low energy expenditure, slowness, and muscle weakness. Multivariate Cox proportional hazard models were used to assess the association between dietary clusters and the risk of frailty and its components. Results: In total, 78 men for 3719 person-years and 221 women for 7027 person-years became frail over the follow-up. In multivariate analyses, men in the “pasta” pattern and women in the “biscuits and snacking” pattern had a significantly higher risk of frailty compared with those in the “healthy” pattern [hazard ratio (HR) 2.2; 95% confidence interval (CI) 1.1–4.4 and HR 1.8; 95% CI 1.2–2.8, respectively; P = .09 and P = .13 for the global test of significance of risk difference across clusters, respectively]. In men, “biscuits and snacking” and “pasta” patterns were significantly associated with higher risk for muscle weakness (HR 3.3; 95% CI 1.6–7.0 and HR 2.1; 95% CI 1.2–3.7, respectively; P = .003 for global test). Conclusions: This 12-year prospective population-based study suggests that some particular unhealthy dietary patterns may increase the risk of frailty in older adults.