Improving cancer care for older people
Dr Shane O’Hanlon is a consultant geriatrician with the Macmillan COCOC team (Comprehensive Care for Older People with Cancer) at the Royal Berkshire NHS Foundation Trust. He tweets @drohanlon
Today is World Cancer Day, and is a good opportunity to take stock of where we are with cancer care for older people.
Many people are surprised to hear that the majority of cancers are now diagnosed in people over the age of 65 years – this group is 11 times more likely to develop cancer than young adults. The incidence of cancer generally has been increasing since the 1970s, but the largest increase has been among people aged 75 years and older. So we really should be offering excellent care to this group, and outcomes should be constantly improving. Is that what is happening?
Although cancer mortality rates are declining, the pace has been slower in the older age group – so in fact there is now a widening gap in outcomes between the young and old. Most cancers also present at a later stage in older people, and of course the outcome is worse if this happens. As well as this, there is evidence that older people are undertreated - ageist attitudes can lead to denial of treatment without due consideration of the individual risks and benefits. With these challenges in mind, it’s clear we need to put some focus on how we provide care for older people with cancer.
For those of us that work in geriatric medicine we have an important role in helping to ensure older people receive appropriate investigation, and have every opportunity to receive treatment where it is an option. Providing comprehensive geriatric assessment for older people who are diagnosed with cancer helps to identify unmet needs – something that is very common. Our COCOC team finds that almost every patient needs some intervention, from medication review to provision of equipment, signposting towards information, or to advocate for their needs. We work closely with our colleagues in oncology and surgery to ensure our team (geriatricians, OT, CNS and patient coordinator) is available where there is an opportunity for us to have input.
Our cancer services put a lot of emphasis on age, when in fact frailty is far more important. All older people with cancer deserve a comprehensive assessment, so we can identify those who are more likely to benefit from "aggressive" treatment. The process also means we can keep patients well-informed, help them to decide their goals and weigh up treatment options. What can you do? Make sure that your local cancer pathways are flexible enough for the very variable needs of older people. Work with your local colleagues in cancer care to explain the need for comprehensive assessment (& optimisation), not reliance on age alone. And ensure that your patients have access to appropriate information about their diagnosis and the opportunity to consider treatment options at their own pace. Our work in the area of geriatric oncology is at an early stage, but we hope that this new collaborative approach can help to improve outcomes over the coming years.