A GM conference report on Professor Jane Maher's session from Clinical Approaches to the Older Patient 2017.
The number of older people living with cancer is set to treble with more than three times as many people aged over 65 years alive with cancer by 2040, amounting to over 4.1 million.1 The majority will have breast and prostate cancer.
More than two in three (70%) people with cancer—1.8 million people in the UK—are also living with one or more other potentially serious long-term health conditions. Almost half (47%) have two or more conditions as well as cancer, and more than one in four (29%) have three or more conditions as well as cancer.2
Surviving cancer does not mean living well. Three in four people living with cancer are in the survivorship stage3 and one in four of them will deal with consequences of their treatment.4 What is not measured is the impact of treatment on independence, incontinence, impaired vision or hearing, impaired cognition and immobility.
In addition, one in five of cancer survivors may have unmet needs.5 This could include timely treatment, planned stages of care with support, supported rehabilitation and aftercare, support for carers and psychological support.
More older people are likely to have cancer diagnosed as an emergency, and often receive less surgery, radiotherapy and chemotherapy for cancer. The reason they often fare worse could be due to either clinical, patient or service factors.
Clinical factors include the focus on chronological rather than biological age and the desire to ‘do no harm’ versus ability to ‘do some good.’ Also some physicians don’t know how to optimise for/adjust treatment, which can be hindered by uncertainty over evidence.
Patient factors include cancer myths such as patients not knowing that the risk of cancer increases with age. Also, although patients are willing to seek help, there is low awareness of services or they might be reluctant to ‘bother the doctor.’
Amongst the service factors are the lack of good links between oncology teams and geriatricians or primary care. Primary care also may not provide helpful information alongside referrals and if they do, they might not necessarily be used meaning that appropriate assessment does not take place.
In Improving Cancer Treatment, Assessment and Support for Older People Project, six principles for the adoption of age friendly cancer care were outlined:6
- Engage elderly care specialists as an active part of the cancer care team and adopt an approach to the assessment and management of all patients.
- Ensure an early and appropriate assessment of an older person is undertaken.
- Ensure everyone gets the maximum benefit from cancer treatment and associated supporting therapies.
- Establish services and clear referral pathways for both outpatients and inpatients to address needs identified by assessment.
- Ensure effective communication systems are in place to facilitate coordinated care and informed decision making.
- Ensure all clinical and non-clinical staff are supported with the training and access to resources required to conduct appropriate assessment and follow-up care of all patients.
1. Maddams J, et al. http://www.nature.com/bjc/journal/vaop/ncurrent/abs/bjc2012366a.html