The substantial increase in the number of very old persons in Norway over the last decades has had a marked impact on the burden of cancer in our society. This project aims to generate knowledge on changes over time in cancer survival and mortality among the very old, here defined as persons 75 years and above. A particular focus directed explicitly towards the very old is warranted because as deaths become more common, competing causes of death must be taken into account, which complicates study design a nd analyses. More specifically, changes in survival from 1988 until today in persons 75 years and older will be described (Part I). Next, changes over time in procedures related to diagnostic and treatment work-up of very old patients with rectal cancer w ill be more specifically looked into (Part II). Finally, variations over time in the sociodemographic and geographical composition of the very old population in Norway will be addressed (Part III).
Norway has registry data that are unique both in quality and size compared to previous international efforts in this field and competent researchers to utlize the comparative advantage this provides. Knowledge that is of relevance both nationally and internationally will be generated.
A particular focus will be directed towards whether or not elderly cancer patients are appropriately handled in the health care system or treated disadvantageously due to their high age. To ensure that patients are treated adequately and independently of individual resources, th e possible presence of a social class gradient in the survival of the very old will be explored. At a more general societal level, this kind of knowledge is important as improvements in cancer survival and mortality among the very old may have an impact o n costs as well as non-economic resource allocation within the health and welfare system, and also be important in deciding not to treat patients due to poor outcome and/or high cost.