Under-treatment is one of a number of factors contributing to around 14,000 avoidable cancer deaths in patients aged over 75 in the UK every year, according to a new report.
Cancer mortality rates are getting significantly better for the under-75s, but they are improving at a much slower rate in those aged 74-84 and actually getting worse for people aged 85 and over, says the study, from Macmillan Cancer Support.
The number of people living with a cancer diagnosis is set to rise from two to four million in the next 20 years, and, with half of all new cancer cases in the UK diagnosed in people aged 70 or over, this is an issue which must be addressed as a matter of urgency, says Macmillan.
According to the report, some of the reasons why older patients are less likely to receive treatment than those who are younger include:
- recommendations on treatment are too often being made on the basis of age, regardless of how fit patients may be;
- assessments do not adequately measure an older person's fitness for treatment, and co-existing health problems are often not identified or effectively managed;
- many patients do not take up treatment because they have inadequate practical support to help them at home, with transport, or with care for dependent spouses and other family;
- older people are not represented on enough clinical trials, reducing the amount of evidence available to clinicians on the benefits and risks of cancer treatment and its impact on quality of life: and
- oncologists and cancer surgeons need more support to manage issues specific to older people such as falls, incontinence and multi-drug use. In a survey of 98 oncology trainees, 60% reported that they have never received any training in the particular needs of older people with cancer, despite them making up half of numbers getting cancer each year, the study reports.
"To deny older patients treatment that could cure them based on ill-founded assumptions is an unacceptable act of discrimination," said Ciaran Devane, chief executive of Macmillan Cancer Support.
"We have a moral duty to treat people as individuals and give them the best chance of beating cancer, regardless of their age," he stressed.
"Efforts are begin made to increase early diagnosis and promote healthier lifestyles, but much more needs to be done to tackle under-treatment. The NHS and social care providers must wake up to the specific issues older people face and ensure treatment decisions are based on their overall health, not just their date of birth," said Mr Devane, adding: "writing people off as too old for treatment is utterly shameful."
Added Professor Riccardo Audisio, consultant surgical oncologist at St Helen's Hospital: " it is despicable to neglect, not to offer, not to even go near to the best treatment option only on the simple basis of the patient's age. This has been a horrible mistake that, particularly in the UK, we have suffered from."
Macmillan has, in partnership with Age UK and the Department of Health, set up five pilots to test new models of older people's care. They will report in December this year.
- Meantime, the National Cancer Intelligence Network (NCIN) reported yesterday that almost 10% of bowel cancer patients die within a month of being diagnosed, and of these 56% are over 80% years old, while 60% have been diagnosed following an emergency admission to hospital.