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Ciaran Devane

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Age Is a Number Not an Excuse to Treat Older Cancer Patients Differently

Posted: 26/03/2012 00:00

Cancer is predominantly a disease of age. Half of people newly diagnosed with cancer in the UK are aged 70 or over. Despite this, there are around 14,000 avoidable cancer deaths in patients over 75 in the UK each year and cancer survival rates in this age group are among the worst in Europe.

Over a decade ago, the Department of Health set the goal of ending age discrimination in the NHS in England, making it clear that services should be provided on the basis of clinical need and not on chronological age. However, there is growing evidence to show age remains a dominant factor when treatment decisions are made and that many older people who could benefit from treatment, like surgery or chemotherapy, just aren't getting it.

There is an abundance of myths surrounding the treatment of older people. People may think that older people can't tolerate chemotherapy or can't be cured. But the days when a cancer diagnosis meant an automatic death sentence are long gone. Older people can be cured with the right treatment.

The diversity of our older population needs to be recognised. You could have one 80 year-old who is very frail, lots of health problems, unlikely to live another year but you could also have another 80 year-old with twenty years of life expectancy. However, current ways of assessing older patients don't adequately measure a patient's fitness for treatment. As a result, treatment decisions often focus on age, regardless of how fit the patient may be.

Geoff's experience highlights this issue. Geoff was diagnosed with prostate cancer last summer. He was 66 and in pretty good nick. When it came to deciding on the best treatment he was offered surgery but he was shocked when his surgeon told him that had he been just four years older, surgery simply wouldn't have been an option.

It's unsurprising cancer doctors and surgeons err on the side of caution when recommending treatment - too much chemotherapy could cause harm to a patient and there's a dearth of clinical evidence to help them make difficult treatment decisions. Over treatment is just as undesirable as under treatment but there are many patients who could benefit from treatment who aren't getting it. We need a better way of assessing older people for treatment and more evidence on the effectiveness and safety of treatments.

We are also concerned that some older patients do not take up treatment because they don't have practical support to help them at home, with transport to and from hospital, or with care for dependent loved one. Without short-term support, many older people may not be able to access or complete their cancer treatment.

Older people are all individuals with differing levels of frailty, mental attitude, and support. Each will tolerate cancer treatment differently. It is vital that steps are taken to ensure that the right people get the right treatment at the correct level of intensity, together with the practical support to enable them to take up and complete the treatment.

Macmillan's newly launched The Age Old Excuse campaign will highlight the issues people over 70 experience during cancer treatment. We aim to improve the treatment of older people, promote best practice among health and social care professionals and empower older people to seek out the treatment and care that's best for them and their cancer.

The number of people diagnosed with cancer is set to rise from two to four million in the next twenty years. With half of all new cases of cancer in the UK diagnosed in people aged 70 or over, this is an issue which must be addressed as a matter of urgency.

For more information about Macmillan's Age Old Excuse campaign, visit www.macmillan.org.uk/ageoldexcuse

 
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