Trends in survival for cancer patients aged 65 years or over from 1995 to 2014 in the United States: A population-based study

Background Adults aged 65 years and above account for over half of all cancer diagnoses in the United States, but little is known about trend of elderly cancer survival in the United States. We aimed to assess the survival trend for elderly cancer in the United States from 1995 to 2014. Methods We used data from Surveillance, Epidemiology, and End Results 12 registries and included 1,112,441 eligible patients aged 65 years or older who were diagnosed between 1995 and 2014 with cancer and followed up until December 2019. Overall and stage-specific 5-year relative survival, ratio of observed survival to expected survival, with 95% confidence intervals (CIs) of elderly cancer patients stratified by age were estimated during four periods (1995-1999, 2000-2004, 2005-2009, and 2010-2014). Cox proportional hazards models were used to estimate hazard ratios for cancer-specific death among patients diagnosed during 2000-2004, 2005-2009, 2010-2014, compared diagnoses in 1995-1999. We also calculated stage distribution and treatment rate during four periods. Results In the United States, 5-year relative survival for elderly cancer patients improved from 57.3% (95% CIs 57.0-57.5) in 1995-1999 to 60.7% (60.5-60.9) in 2010-2014. After controlling for sociodemographic and tumor characteristics, about a 19% reduction in cancer-specific deaths among diagnoses in 2010-2014 compared with 1995-1999. Cancer survival improved for elderly patients in all age groups, with exception of stable survival for patients aged 85 and above. Comparing 1995-1999 with 2010-2014, relative survival improved from 84.7% (84.3-85.1) to 86.7% (86.3-87.0) for localized stage and from 12.4% (12.1-12.7) to 18.7% (18.4-19.0) for distant stage for all cancers combined. The trends in stage distribution and treatment rate for all cancers combined were relatively stable. Conclusions In the United States, survival for elderly cancer patients has improved slightly from 1995 to 2014, possibly mainly due to advances in treatment. Further studies are warranted to explore interventions to improve elderly cancer survival.

Automated summary

The survival rate for elderly cancer patients in the United States has slightly improved from 1995 to 2014, potentially due to advancements in treatment. Except for patients aged 85 and above, the cancer survival rate has improved for elderly patients in all age groups. For all types of cancer, the relative survival rate for localized stage improved from 84.7% to 86.7% and for distant stage improved from 12.4% to 18.7% comparing 1995-1999 with 2010-2014. The trends in stage distribution and treatment rate for all cancers combined remained relatively stable.