Cancer patients experience various problems that relate not only to treatment, but also to psychological, social, and existential issues. These are major stressors, and there is no doubt that each stressor may induce psychological disorders. Since psychological symptoms can cause marked pain and have negative effects on cancer treatment, appropriate interventions must be provided. Thus, cancer is a disease which involves biological aspects as well as many aspects of humanity. Psycho-oncology is a field of study that deals with these aspects of cancer.
Elderly people are known to be different from other age groups in their treatment orientation, capacity to gather information, and ability to judge;however, these issues are often left undiscussed in daily clinical practice. Patients'ability to judge is an important issue in terms of protecting them from any disadvantages caused by making a wrong decision, suggesting the need to conduct sufficient examination regarding their ability to judge in order to provide medical care.

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Among head and neck cancers, cases affecting elderly people are increasing. Radical treatment is sometimes difficult in advanced cases of elderly patients. With progressive cancer, because radical surgery is often difficult, radiotherapy is chosen and may be used together with chemotherapy when overall status is good. However, according to the meta-analysis of Pignon et al., the chemoradiotherapy for elderly patients 71 years old or older, the hazard ratio becomes approximately 0.95, and there is little chemotherapy combined effect. In terms of 5-year survival rate, chemotherapy combined effect is -0.7%.Chemotherapy effect in elderly patients is not clear in past clinical trials. We examined 50 cases 75 years or older treated mainly by radiotherapy at Tokyo Medical Center between February, 2003 and August, 2011. In all, 21 of the 50 patients died, including four who died due to other cancers, while pneumonia accounted for five other deaths. These results suggested that various complications are often present and multiple primary cancers often occur in elderly people. With chemotherapy for elderly people, the effect of radiotherapy treatment and quality of life of the patients should be considered fully based on characteristics of elderly people, and a treatment plan devised accordingly. It is also necessary to undertake care after treatment.

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As the aging society progresses, today more than half of Japanese patients with lung cancer are age 75 years or over. Most elderly patients demonstrate a decline organ function with aging. Elderly people show variable comorbidities, and careful planning is necessary to predict the effect and toxicity of treatment. Large-scale clinical testing to establish a conventional standard therapy was prepared for ages from 20 to 74 years old with selective conditions ; it was not directly be applicable to elderly people. Results of clinical trials on elderly people have been accumulated progressively in recent years. Personalized medicine will become a major paradigm in the care and treatment of lung cancer in elderly patients.

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Esophageal cancer patients are relatively high in age, with most being 70 and over. 5-FU and cisplatin constitute the standard chemoradiotherapy regimen for esophageal cancer. In two retrospective analyses of esophageal cancer patients using 5-FU/CDDP combined with radiation, elderly patients showed a tendency toward poor compliance and higher toxicity than younger patients. The complete response rate of elderly patients was approximately 50-60% and the 2-year survival was 40-50%, which seemed to be lower response and survival compared to younger patients. This may reflect more morbidities and hidden organ dysfunctions in elderly patients. Therefore new strategies are needed for elderly patients to improve toxicities and compliance. A phase II study of weekly administration of docetaxel concurrent with 60Gy radiation was held for elderly esophageal cancer patients was held. The 1-year progression-free survival and 1-year overall survival rate were 66.7% and 85.7%, respectively. Grade 3 esophagitis was observed in 31% of the patients. As observation time was relatively short, more observation is needed to evaluate the efficacy. Other drugs such as paclitaxel or oxaliplatin also have potential as treatment for elderly patients. Evidence in prospective clinical trials is needed.

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This report describes the use of laryngeal preservation surgery for elderly patients with laryngeal and hypopharyngeal cancers as a part of tracheoesophageal surgery. The number of patients with laryngeal or hypopharyngeal cancer who underwent resection of the primary cancer as the initial therapy between 1992 and 2006 was 759 (392 with laryngeal cancer and 367 with hypopharyngeal cancer). Laryngeal preservation surgery for the treatment of laryngeal cancer was performed in 12 patients over 75 years to 80 years of age (34%) and 3 patients over 80 years of age (12%). None of patients over 80 years of age with hypopharyngeal cancer underwent laryngeal preservation surgery with reconstructive surgery and only 2 patients (15%) underwent endoscopic surgery. Laryngeal preservation surgery was not suitable for elderly patients with hypopharyngeal cancer unlike those with laryngeal cancer. Because of the individual variations in their physical conditions, it is difficult to routinely choose laryngeal preservation surgery depending on their age alone. As human lifespan has increased and the retirement age has been extended, the preservation of laryngeal function in the elderly should be given due importance.

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It is known that non-small cell lung cancer (NSCLC) morbidity rises linearly with age. Moreover, since elderly populations are on the increase, it is expected that surgical treatment for such patients will also be more common in the future. Therefore, a rationale for safe and effective surgery is very important to improve surgical outcome.
Careful perioperative care is required to avoid preoperative comorbidity including cardiorespiratory dysfunction in elderly patients, and it is desirable that operations be limited. For example, segmental resection should be considered only for preservation of postoperative respiratory function for lower than performance status (PS) 2, clinical stage I cases.
The recent employment of video-assisted thoracic surgery (VATS) for early-stage NSCLC patients means that safe and satisfactory results can be achieved with less physical stress. We here describe the significance and utility of surgical treatment for NSCLCs in elderly patients considering the progressive aging of societies. In particular, surgical treatment can be recommended as a standard treatment for elderly patients when there is a good PS and relatively minor complicating frailty or disease. Thus, we should choose a treatment strategy suitable for each case taking into account quality of life (QOL) decrease due to preoperative comorbidity, organ functional decline with aging, and complications of surgery.

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Special care should be considered when treating so-called “late-elderly” patients in esophageal cancer clinics. The appropriate therapeutic modality should be selected for each patient based on an evaluation of the patient's organ function and the invasiveness of the therapy. However, symptoms and/or signs may rarely appear in elderly patients even if their organ functions are slightly impaired. Although curability is the most fundamental factor with elderly cancer patients, the effects of treatment on ADL (activities of daily living) are also more important than for non-elderly patients. This view is considered when determining the indications for each treatment, and endoscopic resection is actively applied in elderly patients with superficial cancer. Radiotherapy alone is applied in some elderly cases. Therefore, the short- and long-term outcomes of elderly patients undergoing surgery differ little from is similar to those of non-elderly patients. The physical, mental and social backgrounds of elderly patients vary in comparison to those of non-elderly patients, and a strategy to use minimally invasive therapy with optimal curability is especially important.

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