The Most Common Kind of Cancer Patient in America Is the One We Study the Least

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Former President Joe Biden has been diagnosed with an aggressive form of prostate cancer that has spread to his bones, his office said in a statement on Sunday.

The diagnosis occurred last week, following a urinary screening that revealed a small nodule in his prostate, which revealed the aggressive Stage 4 prostate cancer, according to the statement. The office added, “The cancer appears to be hormone-sensitive which allows for effective management.”

Biden released his first statement regarding his diagnosis on Monday. “Cancer touches us all,” the 82-year-old wrote on X. “Like so many of you, Jill and I have learned that we are strongest in the broken places. Thank you for lifting us up with love and support.”

Biden's cancer diagnosis is equal parts tragic and ironic. It's tragic because a cancer diagnosis is always tragic. It means long treatments that can be painful and debilitating, lots of waiting and worrying, and the very real possibility that you might not survive, even under the best circumstances. The former president will have access to excellent care without fear of medical debt—something not every American can say. But that guarantees very little.

On top of that, in 2015 Biden's older son, Beau Biden, died at 46, after being diagnosed with one of the most aggressive types of brain cancer. Biden's experience in supporting and eventually losing his son greatly influenced his decision to spearhead the Beau Biden Cancer Moonshot, a research initiative that aims to cut cancer death rates in half by 2047. The project was initially launched in 2016 under the Obama administration and later reignited in 2022, under then-President Biden. It received $1.8 billion in funding through the bipartisan ^21st Century Cures Act to support more than 250 research projects and 70 programs with the goal of supporting patients and their families and ultimately ending cancer for good.

But therein lies the irony: The vast majority of cancer trials exclude older patients like Joe Biden, despite the fact that most patients who get cancer are over the age of 65. Although the Food and Drug Administration released guidance around the reignition of the Cancer Moonshot to help the issue, it remains a systemic problem.

Cancer can affect anyone, but it disproportionately happens for older people. Roughly 60 percent of all cancer diagnoses and about 70 percent of cancer deaths occur in patients 65 or older. Yet a 2024 study published in the journal BMC Cancer examined 7,747 clinical trials on cancer and found that only 25 percent of cancer trial participants are over 65 years old.

A 2019 study in JAMA Oncology found that in clinical trials the median age of participants with common cancers such as breast, prostate, and lung cancer was nearly six and a half years younger than the median age of people actually diagnosed with the disease. Even though prostate cancer trial participants skewed slightly older due to the cancer type, participants were still three and a half years younger than the average prostate cancer patient.

There are several factors at play here. For one, a lot of clinical trials have strict criteria to determine who exactly gets to participate in cancer studies. Supriya Mohile is a geriatric oncologist with the University of Rochester Medical Center whose research sheds light on the underrepresentation of older adults in cancer trials. She tells Slate that although studies have gotten better about not restricting on the basis of chronological age, older adults are still underrepresented due to eligibility criteria that favor fitter patients.

“We don't do a good job assessing fitness for older patients with cancer,” Mohile said. “Sometimes we see older people in the clinic, and one doctor might say, 'Oh, you're 80. You're too old for this clinical trial,' even when they're pretty fit and they don't have a lot of other things going on.”

She puts it another way: Clinicians often rely on an “eyeball test” to assess patients—but that type of appraisal is subjective, imperfect, and likely to vary from clinician to clinician. She highlights the need for more objective measures when determining someone's eligibility for clinical trials like the Comprehensive Geriatric Assessment, which is a tool to evaluate function, psychological status, cognition, and physical strength in older adults.

Often, those with complications related to age, including comorbidities and reduced organ function, are excluded from trials. Older folks are also less likely to be able to tolerate experimental treatments, which frequently results in their exclusion. This age disparity is an issue not just for cancer research, but also in other fields, including cardiovascular , neurological , and psychiatric studies.

This causes blind spots in our medical systems and treatments, which are designed without older bodies in mind. Clinicians base the drug doses, side effects, and expected outcomes on younger participants—which can result in older patients becoming over- or under-treated, experiencing unexpected side effects, and leaving their doctors guessing as to their care outcomes.

Mohile notes that, following the release of the new FDA guidance in 2022 on including older adults, she worked with a multidisciplinary team that included academics, clinicians, and advocates in the National Cancer Institute and FDA to develop a series of articles that outline best practices to improve recruitment of older adults for clinical trials.

However, the recommendations were just that. Age-related disparities in cancer research and health care as a whole remain in place. “The challenge was that there's no carrot or stick,” Mohile said. She added, “I don't think it's as much as it needs to be still—and I don't know if that'll change.” Would Biden, at the age of 82, even qualify for the trials funded under his own initiative? Mohile stops short of ruling it out (and notes that an experimental treatment might not be the best course of action for him anyway). Still, the fact is that cancer research is built largely around younger, healthier bodies.

Aside from the findings of the research, the trials themselves can be bastions of hope, and enrolling in them can be a last resort for many with cancer—providing access to experimental treatments that give them a fighting chance. When you get turned away from that, it can be devastating, no matter how old you are.

This is ageism, pure and simple—and it's a problem in not just medicine but society in general. We devalue older adults. We associate increased age with decline and irrelevance. Older people are seen as a burden rather than members of society who deserve dignity, respect, and attention, just like anyone else. Economic incentives deprioritize the complex, long-term care these folks require—and encourage our willful ignorance of their needs.

Yet we have all the more reason to design medicine that actually accommodates the complexities of aging bodies. If most older patients have a comorbidity, then that's not a reason to exclude them from trials—it's the reason to include them. It doesn't matter if it's complicated and expensive. Medicine shouldn't be designed around “ideal” bodies; it should rise to meet real ones.

It's not a stretch to say that the future of society depends on our research on and attention to older adults, including those suffering from multiple ailments at a time. The global population is getting very old, very quickly. Those age 65 and older are the fastest-growing demographic group on Earth, according to the United Nations . In the US alone, that cohort will make up roughly 25 percent of the population by 2060, compared with just 16.8 percent today.