CAN-EVOLUTION

The evolution of cancer in ageing societies: An international perspective

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 Obiettivo del progetto (Objective)

'This project is a training-through-research project that aims to describe the global evolution of cancer in the ageing societies using international comparison studies. Three theories have been proposed to explain the dynamics of ageing populations: compression of morbidity, expansion of morbidity, and dynamic equilibrium. Yet, these theories have never been applied to understand the evolution of cancer, a disease that occurs primarily at old age. Using global databases, I will assess the population impact of changes in longevity and duration of morbidity among patients with cancer. I hypothesize that increases in life expectancy after cancer diagnosis have primarily led to expansion (longer time spent with disease before death) rather than compression of years lived with illness and disability. Life table analysis weighted for severity of cancer types to derive disability-adjusted life expectancy will be used to assess the evolution of cancer in ageing societies. This is the first study to apply the dynamics of aging population theories to unravel how cohort of cancer patients can be expected to evolve after survival. The study will also provide an important base for applying these theories in the aging theories in general and to solve health care issues pertinent to this frail population. Parallel to the scientific activities aimed to describe the dynamic of ageing among cancer patients, this project will provide various training opportunities to increase my competence in analysing large databases, in communication and teaching, in writing scientific articles and it will also substantially increase my collaborative network. The combination of renowned scholars with the available resources and access to international networks makes the host institution (International Agency for Research on Cancer) the best place to spend a mobility period to carry on this project. It will also significantly benefit my future career development.'

Introduzione (Teaser)

Cancer is a disease most prevalent in the elderly and provides a good window from which to see the effects of increased life expectancy on morbidity. Scientists have developed a pioneering and timely framework describing this relationship.

Descrizione progetto (Article)

As the ageing population grows in many countries, understanding issues related to its morbidity and mortality becomes more pressing. It impacts on health care and its costs and on quality of life, among other things. For example, although cancer patients are living longer, they may actually have expanded morbidity (more time spent with disease before death) rather than compressed due to other conditions caused by cancer therapies.

The EU-funded study 'The evolution of cancer in ageing societies: An international perspective' (CAN-EVOLUTION) was the first to apply theories regarding the dynamics of ageing populations to cancer evolution. A global assessment of the burden of cancer relative to other non-communicable diseases (NCDs) revealed that cancer now outranks coronary disease and stroke as the leading cause of death worldwide. Cancer is a very large component of the NCD-related deaths in high-income countries.

A review of incidences of cancer in 26 countries over the period from 1988 to 2010 revealed that high tobacco-related cancers among men have been declining whereas lower rates among women have been increasing. Incidences of four common cancers (prostate, postmenopausal breast, corpus uteri and colorectal) in Central and Eastern Europe have been increasing to approach western and northern European levels. There was a growing incidence of breast cancer in all countries and especially in those where the greatest decreases in mortality from other cancers was found.

Overall, results emphasise the importance of focusing on healthy lifestyles and not only restricted tobacco use for cancer prevention. They also highlight the need to do so in all geographical regions regardless of socioeconomic indicators.

The project developed a first-of-its-kind theoretical framework describing the relationship between life expectancy and disability for many type-specific cancers and other chronic diseases. The review will be published in the Disease Control Priorities, Third Edition of the Disease Control Priorities Network (DCPN). Additional scientific papers and several sub-chapters of the global Cancer Atlas ensure that the outcomes will reach a broad scientific audience as well as the public. Increasing global awareness of cancer and cancer education will promote cancer control.