“…Several studies have suggested that increasing age is an adverse prognostic factor in RCC, with older age associated with higher tumor stage and grade (Denzinger et al , 2007; Verhoest et al , 2007; Karakiewicz et al , 2008; Jung et al , 2009), although others have found that age has little impact on presentation or survival (Doherty et al , 1999; Thompson et al , 2008; Scoll et al , 2009). In general, survival tends to be poorer in older cancer patients (Bouchardy et al , 2003; Petignat et al , 2004; Quaglia et al , 2009; Janssen-Heijnen et al , 2010), reflecting a complex picture of less frequent referral to cancer specialists (Tyldesley et al , 2000; Delva et al , 2011); inadequate treatment (Mor et al , 1985; Earle et al , 2002; Easson et al , 2002; Bouchardy et al , 2003; Houterman et al , 2006; Vulto et al , 2006); and impact of comorbidities (Extermann, 2007), since older patients are at significant risk for multiple comorbidities (e.g., 35% of patients age 65 years or older who are eligible for both US Medicare and Medicaid have ⩾4 comorbidities (Fox and Reichard, 2013)). In addition, aging trends will only exacerbate this issue.…”