Older lung cancer patients in the UK are five times less likely to be given potentially life-saving surgery than younger patients, new research by Macmillan Cancer Support in partnership with Monitor Deloitte and Public Health England’s National Cancer Intelligence Network, has shown.

The reasons for this, says Macmillan, are complex. In some cases it may simply not be appropriate to operate on a patient, but its research has found that sadly this is not the only scenario.

Current assessment methods are often inadequate, leaving many older cancer patients assessed for treatment based on their age alone and not their overall fitness, it said, and noted that other factors, such as difficulties elderly patients may face in getting to and from hospital, are also playing a role and could be addressed. 

This has created a situation in which England and Wales have the worst five-year survival rates for lung cancer in Europe among the over 75s, and the UK carries out less lung cancer surgery on older people than in other European countries, the charity said.

“If we don’t take heed of these figures now, things will get worse," warned Ciarán Devane, Chief Executive at Macmillan Cancer Support. 

“The NHS must ensure every older patient is treated based on their overall fitness, not their chronological age, he said, and added that the charity is "urging all main political parties in the run up to next year’s general election to commit to improving cancer survival rates, especially for older people". 

'Discrimination within the NHS'

In an emailed statement to PharmaTimes, Caroline Abrahams, Charity Director at Age UK, said the research "once again demonstrates that older people can experience discrimination within the NHS and that the chances of receiving high quality care are all too often stacked against them".

“Decisions about who should and should not be given surgery should be based purely on clinical need - anything else is blatant age discrimination”.

Sean Duffy, National Clinical Director for Cancer at NHS England, stressed that cancer treatment "should always be based on what is right for each individual patient, not their age", and that "clinicians must make an objective assessment". 

But "it’s clear that much more needs to be done to ensure older patients have equal access to treatment," he said, noting that NHS England has established an advisory group "to examine all existing evidence so we can identify where real improvements can be made in cancer services for older people".

Want to know more? PharmaTimes World News further questioned Macmillan on the findings:

PT: Did you notice any geographical variation in lung cancer surgery rates for the elderly?

Macmillan: Unfortunately, we can’t break down our research published today regionally. However, there is previously published research on [this]. The National Lung Cancer Audit Report 2012 showed that the percentage of lung cancer patients receiving surgery varied between trusts reporting in the audit. For example, for University Hospitals of Leicester NHS Trust the percentage of NSCLC (non-small cell lung cancer) patients having surgery was 15% higher than those in Lancashire Teaching Hospitals NHS Foundation Trust.

The National Cancer Intelligence Network (NCIN) also published a report in 2011 which showed variation in the proportion of patients having major surgery around the country for a range of common cancers between 2004-2006. Worryingly the report showed that some parts of the country have different rates of surgery compared to other regions.

PT: Who designs current assessment methods for lung cancer treatment, is there not a standard one?

Macmillan: There is currently no standard assessment framework for older patients. Cancer treatment involves assessing a range of complex patient characteristics in order to recommend a series of interventions which both maximise potential efficacy and minimise potential side effects. We know that clinicians have raised concerns that current methods of assessing older patients often do not provide them with sufficient information to make an appropriate cancer treatment recommendation.

Macmillan is currently establishing the first Geriatric Oncology Expert Reference Group to scope whether an overall assessment framework could be created from existing assessment methods.

PT: Surely it would be more cost effective for patients to undergo surgery where possible rather than receive treatment with costly cancer drugs further down the line?

Macmillan: We don’t have any precise data which shows that surgery for older lung cancer patients is cost effective. However, more generally we know that poor care is often more costly care. The cost of a person’s treatment varies considerably depending on their survival profile. Unsurprisingly, people whose cancer spreads or comes back cost more to treat than those who survive a similar amount of time but whose cancer doesn’t spread or recur. More unexpectedly, when people have other serious health conditions as well as cancer, the cost of their care after their first round of cancer treatment is often more than the cost of the cancer treatment itself.

These findings suggest that giving people better survival outcomes could save the NHS a considerable amount of money.

PT: Do you think there is a similar picture for elderly patients suffering from other forms of cancer?

Macmillan: We know that over all, surgery rates for cancer do decline with age. However, it’s not very clear why this is happening and more research is needed to understand the root causes. Previously it hasn’t been known whether this lower rate of surgery is clinically appropriate, as older people tend to have more long term conditions, are more likely to be diagnosed later when their cancer has spread or might be opting out of treatment. However, our research shows that there are otherwise healthy, older lung cancer patients, whose cancer hasn’t spread, who aren’t getting treatment. So this certainly provides a compelling need to investigate the rate of surgery for other cancers by age.