The so-called “silver tsunami” is a metaphor that the individuals 65 and older represent the most rapidly growing segment of
the Western world population.
Aging is an ongoing process that leads to the loss of functional reserve of multiple organ systems, increased susceptibility to stress, it is
associated with increased prevalence of chronic disease, and functional dependence. Determined by a combination of genetic and environmental
factors, this process is highly individualized and poorly reflected in chronologic age. The heterogeneity and the complexity of
the older old population represent the main challenge to the treatment of cancer in those patients. We should discern "fit" elderly in whom
standard cancer treatment appears to be comparable to a younger population and “unfit” or "frail" elderly, in which the risks of the treatment
may overwhelm potential benefits.
There are many aspects that have to be assessed before treating an elderly patient, or before to choose the treatment itself. In our review
we will try to explain and describe the meaning and the most important aspects related to the oldest old complex patients, and how to
manage those patients.