Is chemotherapy underutilized in the elderly

Is chemotherapy underutilized in the elderly? Yes, most probably. Back in 1990, a group of pioneers in the field of geriatric oncology published a provocative editorial entitled ‘Why are elderly cancer patients badly treated?’ [1]. Eminent members of the same group recently concluded their scientific review on the treatment of cancer in older patients by writing: “Although we are on the right track, there is still a long way to go” [2]. Answers have thus been provided in the interval between these two communications but many questions still remain. There have been remarkable societal changes in the 20th century and the unexpected lengthening of life-expectancy has been one of the most crucial. Previously, the third and the fourth age were the privilege of few lucky individuals, capable of escaping from misery, epidemics and catastrophes. Today, the vast majority of us may expect to get old and to live these years in very good health. However, parallel to the aging of the population, cancer disorders have increased in number and over half are now diagnosed in the eight, ninth and tenth decades of life. If the incidence of cancer is 207/100,000 below 65 years of age, it rises to 2261/100,000 above that age, that is, 11-fold higher [3]. In other words, cancer has now become a disease of the elderly. It is predicted that 15 million new cases of cancer will be diagnosed worldwide in the year 2020 in comparison with 10 million 20 years before [4]. And the evidence is that the majority will concern people over the age of 70 years, the senior adults. These numbers demand serious analysis. What we have learned over the past years should be used to prepare for the future in the full respect of the ethics of our societies. To find the balance between autonomy, beneficence and justice is a major challenge. Despite scientific advances in the