Aging and Cancer: A new forum for research that spans disciplines and seeks new answers

Do we really need another journal? Certainly, that was my initial reaction. Until I gave it some thought. Aging impacts everything about cancer, from incidence, to progression, to prognosis, to therapeutic options and their outcomes, to the psychosocial aspects of living with cancer. Note that 90% of cancers are diagnosed in those aged over 50 years.¹ Age is the dominant risk factor for both cancer incidence and mortality. Cancer is clearly a disease of aging. Historically, these links have been understudied and underappreciated, with aging mostly considered simply as the time to accumulate enough mutations to generate a cancer. Insufficient attention has been given to the aging-dependent changes in cells, tissues, immune function, and overall body fitness that influence the genesis and pathology of cancer, and outcomes for patients. But times are changing. There is increasing recognition of these connections in the research community and in funding agencies (in the United States, the National Institute of Cancer, the National Institute of Aging, and the Samuel Waxman Cancer Research Foundation have teamed up to fund research in this area, as well as workshops and focus groups). This interest is perhaps driven by the reality that the fraction of people on our planet above 65 years will double in the next few decades. Since most cancers occur in the elderly, we need to understand why and what we can do about it. The Silver Tsunami is upon us.

As the newest member of the Wiley family of scientific journals, Aging and Cancer will provide an important forum for new results and ideas that improve our understanding for how old age influences many different facets of cancer, from incidence, to its development and pathology, to treatment outcomes. Thus, the journal will span the aging and cancer field from basic biology (from computational modeling to molecular/cellular studies to model organisms to evolutionary biology), to clinical sciences (responses to therapy and outcomes research), to population health (cancer risk and survivorship). We will publish a variety of article types, from original research (including brief reports) to reviews and perspectives to editorials and white papers.

Links between old age and higher cancer incidence should be recognized for their fundamental importance in understanding biology in general. Following the early ideas of Medawar, Williams, Hamilton and more recently Kirkwood,^2-5 the 10 000 foot (evolutionary) explanation should be clear: there is minimal selection against diseases of old age, including cancers, beyond ages where contributions to future generations was likely (at least under “natural” conditions).⁶ Natural selection has tuned somatic maintenance programs to maximize reproductive output, and this maintenance wanes at older ages where reproduction becomes less likely. This physiological aging, which those of us over 50 can attest to, substantially impacts disease risks from kidney failure, to infectious diseases, to coronary disease, to cancers.⁷ Relatively recent studies, mostly in model organisms, have demonstrated how aging-dependent alterations in tissue microenvironments, immune function, and inflammation can contribute to cancer risk (reviewed in Ref. 8). Aging and Cancer will be a forum for basic research using model organisms of all types and spanning from the molecular (telomeres, DNA repair, inflammatory signaling, etc.), to organismal (systemic changes, animal models of cancer, development of interventions, etc.), to the population level (population genetics, field studies, and human epidemiology).

To give one example for why we need a new perspective on the importance of aging in cancer, and why we need a designated forum for such ideas, consider immune therapies. We know that the vast majority of cancers occur in the elderly, and thus most immune therapies will be given to the elderly. We also know that our immune system, both adaptive and innate, undergoes dramatic changes as we age.⁷ And yet almost all preclinical development of immune therapies is occurring in young animals (mostly mice). Manuscripts describing studies to understand how age influences immune function and responses to immune therapies would be very welcome for Aging and Cancer.

Such discrepancies are also evident in the clinical realm. While 61% of real-world cancer patients are over 65, only 25% of cancer patients participating in clinical trials are over 65.⁹ How will the development and testing of therapies in younger (and likely healthier) patients impact their efficacy and safety for the elderly population after FDA approval? We welcome manuscripts (from editorials to original research) that deal with critical aging-related issues that impact clinical research and patient outcomes.

If you are thinking that this journal sounds very broad, that is by design. We believe that a multidisciplinary forum will promote cross-fertilization spanning fields. Not only should ideas and results from basic science be translated toward improvements in patient care, but epidemiological and clinical observations should stimulate basic research into underlying mechanisms. For example, we have known for decades that immune function is impaired in the elderly,⁷ which has stimulated basic research over these same decades into why this is. We also know that drug pharmacokinetics and pharmacodynamics change in older ages,¹⁰ which should similarly stimulate basic studies into the underlying reasons.

I am proud to introduce our distinguished editorial board and advisory board.

We are also extremely proud to partner with the Samuel Waxman Cancer Research Foundation, which has heavily invested and promoted research into connections between aging and cancer.

We also hope to partner with you as researchers interested in better understanding of connections between old age and cancer, fellow readers of the journal, reviewers of manuscripts, and of course authors of content. Feel free to reach out with questions or comments. We welcome your involvement.