Healthcare Atlas for the Elderly, 75 yr and older Helseatlas Non-surgical cancer treatment, 2013–2015 SKDE

Each year, approx. 10,500 new cases of cancer are diagnosed in the age group 75 years and older. The number of new cancer cases among the elderly is expected to increase by 76% to approx. 18,000 in the period up until 2030. This is mostly due to the expected 60% increase in the number of elderly people during the same period. The increase in the number of new cancer cases will place great demands on the capacity and expertise of hospitals, particularly because elderly patients often have other medical conditions in addition to cancer.

Background Results

Several effective new drugs have become available for the treatment ofcan- Each year, 40% more new cancer cases are diagnosed among the elderly in cer in the past ten or fifteen years. There is no upper age limit for treatment hospital referral area than in the area. with these drugs, but the risk of serious side effects increases with age and Each year, 3,250 elderly patients receive pharmacological cancer treatment, may limit their use. Patients will often tolerate radiotherapy better than phar- while 3,050 undergo radiotherapy. For both forms of treatment, there was a macological treatment and surgery. trend towards more elderly patients being treated during the period. Elderly cancer patients are under-represented in clinical studies. Decisions Residents of Vestfold hospital referral area have pharmacological cancer and treatment choices are often based on the results for younger and healthier treatment twice as often as residents of Finnmark. Residents of Sørlandet patients. Elderly patients’ suitability for treatment must therefore largely be hospital referral area undergo radiotherapy twice as often as residents in the individually assessed on the basis of their biological age and general state area. of health - and as shared decision-making with the patient. Pat. Cons./pat. Pat. Sørlandet 223 10.3 Vestfold 598 307 11.6 Stavanger 624 OUS 141 11.5 Sørlandet 636 Fonna 129 11.8 Bergen 916 UNN 134 8.1 Inner 386 Møre og Romsdal 197 14.7 Fonna 405 103 9.6 a

Vestre 1,035 e Stavanger 178 13.6 r a a

111 13.4

e 633 Østfold l Inner Oslo r a a r

10,405 r 3,056 12.2

l Norway e a f r 295 9.9 r 390

UNN e Innlandet r e

f 401 l 170 13.3

e St. Olavs

Telemark a t r i

l

Akershus 797 p Finnmark 42 8.9 a s t i o

p Møre og Romsdal 581 Østfold 175 13.1 H s

o Helgeland 185 225 15.1 H Nord-Trøndelag 310 Vestfold 133 14.0 St. Olavs 555 Nord-Trøndelag 79 11.7 Førde 257 Helgeland 47 9.5 Nordland 284 Vestre Viken ● 2013 232 14.0 OUS ● 2013 390 Førde ■ 2014 57 11.7 Innlandet ■ 2014 901 Telemark ♦ 2015 77 12.1 Finnmark ♦ 2015 120 0 2 4 6 8 10 12 0 10 20 30 Number per 1,000 inhabitants (≥75 years old) Source: NPR/SSB Number per 1,000 inhabitants (≥75 years old) Source: Cancer Registry of Norway/SSB Radiotherapy, number of patients per 1,000 population, adjusted for gender New cancer cases in Norway per 1,000 population, 75 years and older, adjusted and age. Av. number of patients and appointments per patient per year. for gender and age. Av. number of new cases per year.

Pat. Cons./pat. Comments

Vestfold 218 5.7 Stavanger 203 6.2 There is a certain degree of correlation between the use of pharmacological Møre og Romsdal 215 7.1 cancer treatment and the incidence of new cases in the hospital referral areas. Nord-Trøndelag 118 6.1 Vestre Viken 337 7.1 Differences in morbidity, combined with random variation, can therefore Sørlandet 196 6.4 explain part of the variation in pharmacological cancer treatment, but not Telemark 132 6.4

a the whole observed variation. It is probable that assessments of the risk/be-

e Inner Oslo 113 7.2 r a

133 7.7

l OUS nefit to the patient differ between hospital referral areas. If the individual a r

r Norway 3,252 6.6

e assessment of patients is inadequate, fear of undesirable incidents in frail f 182 6.3

e St. Olavs r

l Akershus 262 6.3 patients could result in more robust patients also missing out on treatment. a t i

p Fonna 115 5.5 s o Førde 81 7.1 There is no correlation between radiotherapy use and cancer incidence. The H Bergen 237 6.3 Innlandet 275 6.3 nine hospital referral areas with the lowest radiotherapy rates do not have a Østfold 170 8.4 radiotherapy centre, and proximity to a radiotherapy centre therefore appears Helgeland 52 6.9 to have a bearing on whether or not elderly patients receive radiotherapy. UNN ● 2013 104 5.8 Nordland ■ 2014 73 6.5 Finnmark ♦ 2015 35 5.1

0 2 4 6 8 10 12 14 Number per 1,000 inhabitants (≥75 years old) Source: NPR/SSB

Pharmacological cancer treatment, number of patients per 1,000 population, adjusted for gender and age. Av. number of patients and appointments per pa- tient per year.

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