Abstract
The incidence of most types of cancers is age-dependent and the progressive ageing is rapidly
increasing the number of elderly people who need treatment for cancer. Elderly patients present
peculiar characteristics that make the choice of the correct treatment more difficult and these
patients are often undertreated. Moreover, elderly patients are largely underrepresented in cancer
treatment trials, and this makes the experimental evidence on this topic even weaker. Healthrelated Quality of Life (QOL) has been considered as one of the hard end-points for clinical cancer
research, and treatment of elderly cancer patients represents a typical situation where its
assessment can be particularly useful, because the expected toxicity of treatment could be relevant
in the discussion of the treatment choice. However, QOL assessment in the elderly is complicated
by several unresolved methodological problems (higher frequency of illiteracy, worse compliance
with the questionnaires, concomitant diseases, use of instruments not validated in the aged
population). Conduct of clinical trials dedicated to elderly patients is now encouraged but there are
few published studies. Advanced non-small-cell lung cancer is one of the fields with the largest
amount of research on QOL in elderly patients. The ELVIS study demonstrated the efficacy of
single-agent chemotherapy, both in terms of QOL and of survival. The MILES study, in which
combination chemotherapy was not superior than single agents, showed that baseline QOL is a
strong prognostic indicator in these patients. QOL of patients with breast cancer has been another
important field in clinical research over the last decades, and interest on this topic in elderly
patients is growing, from loco-regional to palliative treatment.
In conclusion, some steps have been done in clinical cancer research dedicated to elderly patients,
and the role of QOL assessment in this setting is important. However, many methodological
problems must be resolved, in order to obtain reliable and useful results. A QOL assessment could
also be useful for elderly patients in clinical practice, where it could improve patient-clinician
communication: a wider application of properly selected instruments should be recommended.