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Improving Care for Older Cancer Patients

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Of all the challenges facing society in the UK, it is telling that the departing Archbishop of Canterbury chose how we treat the elderly to be the topic of his last speech to the House of Lords. In the words of Dr Rowan Williams, all too often when it comes to older people we "look impatiently at our watches, waiting for them to be 'off our hands". Nowhere is this issue more urgent than in the health and social care sector - and cancer care in particular.

Nearly half of healthcare professionals involved in the treatment of cancer patients say that stereotypes and assumptions held by their colleagues result in patients not getting the most effective care. Many cancer services staff receive little or no training on the specific medical needs of older people. While cancer mortality rates are improving significantly for the under 75s, they are improving at a much slower rate in those aged 74-84 and actually getting worse for people aged 85 and over. Older cancer patients are also less likely to be assigned a dedicated clinical nurse specialist or receive the right kind of information about treatment side-effects.

This is all despite the fact that cancer is largely a disease of age: six in ten new cancer patients are aged 65 and over. Our cancer services are failing to meet the needs of their largest group of patients.

The moral imperative to root out this ageism in the NHS now has legal backing, following the recent expansion of the age-related provisions of the 2010 Equality Act to include services. All public sector organisations must eliminate unequal treatment on the grounds of age. But where do we start in cancer care?

To make the most impact with limited resources, we need evidence to guide our decisions. That's why Macmillan Cancer Support has just completed a pilot programme involving more than 700 older cancer patients from 14 NHS trusts. Five pilot sites, run in partnership with the Department of Health and Age UK, introduced new methods of assessing elderly patients prior to, and during, cancer treatment.

Two of the most pressing findings from the pilots are the need for more clinical input from elderly care specialists, and more widespread use of comprehensive geriatric assessments (CGAs). At Guy's and St Thomas' NHS Foundation Trust and Bexley NHS Care Trust, making adjustments to care such as using a CGA and including a geriatrician as part of a multidisciplinary team significantly reduced the length of inpatient stay and helped many patients tolerate treatment better. In a second pilot in the Mersey and Cheshire Cancer Network, patients with age-related conditions such as dementia and sensory impairment particularly benefited from enhanced assessment.

Unsurprisingly, such comprehensive assessment will identify more care needs. Seven in 10 patients screened for a full CGA at the Guy's and Bexley trusts had three or more co-morbidities. Of the first 70 patients assessed at the Royal Berkshire Hospital NHS Foundation Trust, four in ten needed help with preparing meals and almost a quarter were completely unable to shop for themselves.

We must not shy away from this challenge. Addressing the unmet needs of older patients will put them in the best possible condition to benefit from cancer treatment. Health and social care providers must work hand-in-hand with the voluntary sector to ensure this happens. As Dr Williams points out, older people are participants in society, not merely passengers. There can be no age-related excuses -- medical, social or financial -- that stop older patients taking up the treatment they rightfully need and deserve.

To read the full pilot report, and for more information on Macmillan's Age Old Excuse campaign, visit www.macmillan.org.uk/ageoldexcuse