The Connecticut Cancer Plan burden chapter addresses the issues surrounding the highest burden cancers in the state. See State Cancer Profiles (27) for resources and data on other cancers. Lower burden cancers that are preventable by vaccination, such as cervical cancer are addressed under Goal 1.
CANCERS INCREASING IN INCIDENCE AND MORTALITY RATES
In Connecticut, the majority of age-adjusted incidence and mortality rates for specific types of cancer and the overall cancer incidence and mortality rates are falling. However, both the incidence (Figure 1) and mortality rates (Figure 2) (28) for four cancer sites are increasing, namely pancreas, uterus, liver and bile duct, and oral cavity and pharynx. Cancer of the brain and other nervous system (ONS) has had an increase in mortality rate but not an increase in incidence rate; notably the increase in mortality is not significant.
An increase in obesity rates may account for some of the increase in cancers of the uterus, pancreas and liver. (29) Some portion of the increase in liver cancer is likely due to a relatively high prevalence of hepatitis C infection in specific sectors of the population. The increase in oral cavity and pharynx appears to be due to an increase in human papilloma virus-related cancer, as in contrast to HPV-related oral cavity and pharyngeal cancers, tobacco-related oral cavity and pharyngeal cancers are declining due to declining rates of tobacco use. (30)
Changing trends in cancer incidence and mortality for Connecticut provide useful data to monitor progress against cancer in the state. Increasing trends in cancer incidence and mortality should prompt investigation into the causes of such change and subsequent interventions to mitigate causative factors or behaviors.
THE AGING OF THE POPULATION
A 2013 draft report from the Institute of Medicine addresses another increasingly important issue in cancer control. (31) In the report entitled “Delivering High- Quality Cancer Care: Charting a New Course for a System in Crisis: Addressing the Challenges of an Aging Population” the authors spell out additional considerations for caring for the burgeoning older cancer patients.
“Cancer care for older adults …is especially complex. Age is one of the strongest risk factors for cancer and there are many important considerations to understanding older adults with cancers’ prognoses and formulating their care plans, such as altered physiology, functional and cognitive impairment, multiple coexisting morbidities, increased side effects to treatment, distinct goals of care and the increased importance of social support. The current health care delivery system is poorly prepared to address these concerns comprehensively. Thus, addressing the needs of the aging population will be an integral part of improving the quality of cancer care.
..In addition, there are less data from clinical trials to guide treatment decisions in older patients.
…Stereotypes held by clinicians about older adults may also deter them from treating patients aggressively (Foster et al., 2010).
Older adults with cancer may have different treatment goals or preferences than younger patients with cancer. Clinicians’ treatment recommendations are greatly impacted by their patients’ age, comorbidity and health status and do not always take into account individual preferences (Hurria et al., 2008). Clinicians’ communication styles and their own treatment preferences also have an impact on the type of care older adults with cancer receive.”
The report recommends ten strategies to address these issues and improve the quality of cancer care for older adults (see “For More Information”).