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Around two in every hundred of the UK’s over-75s are diagnosed with cancer each year. And this accounts for around a third of the nation’s new cancer cases each year.
But because life expectancy in the UK is increasing, the number of older people living with cancer is growing. By 2020 there will be nearly two million people aged 65 and over alive following a diagnosis of cancer.
But are the UK’s cancer services geared up to support the older generation?
Today, a report exploring this question is launching at this year’s Britain Against Cancer Conference in London. It draws together evidence on what we know, and what we still need to understand, about cancer and older people in the UK. The report was commissioned by Sean Duffy, NHS England’s National Clinical Director for Cancer, and is published by the National Cancer Intelligence Network (NCIN) in association with Cancer Research UK and Macmillan Cancer Support among others.
So what were the report’s key findings and recommendations?
Healthy living is important at any age
When it comes to cancer risk, being a non-smoker, cutting back on alcohol, keeping a healthy weight and staying active are the best ways to stack the odds in your favour.
But – as the evidence in the report shows – older people are less aware of this than other age groups, despite the fact that being overweight and inactive is more common in older people than in the population as a whole.
And it’s not just about avoiding cancer. If you do get cancer, then the fitter you are in general, the better – it increases your chances of being able to have more aggressive (but more effective) cancer treatments.
Early diagnosis is a challenge in older people
Diagnosing cancer early saves lives – but the report shows that older people with cancer are more likely to be diagnosed via an emergency hospital visit, usually with a more advanced cancer
That’s probably due to a combination of factors. Research shows that older people are less aware that symptoms like a lump or sickness are possible cancer warning signs, so they may be less likely to tell their GP if they’re having those symptoms.
They also might have complex health needs to start with, so it’s harder for their GP to work out the root cause of a new or existing symptom – after all, many possible cancer symptoms stem from a range of other illnesses too.
Too old for treatment?
The report draws together the evidence that the use of surgery (as we also blogged about last week), chemotherapy and radiotherapy tails off as we get older. This is probably one reason (among others) why cancer survival is lower for older people. It’s tempting to interpret this as simple ageism, but there are plenty of good reasons why an older person mightn’t receive these treatments.
As we’ve covered already, older people may not be fit enough for aggressive treatments. Their cancer might be too advanced for certain treatments to work, or there might be other treatments which work better for their type of cancer. And, we mustn’t forget, sometimes quite understandably, older patients decide with their doctors that they just don’t want to put themselves through treatment.
But the variation in treatment by age suggests that decisions not to give older cancer patients active treatment are not always based on these good reasons. The report discusses the fact that, sometimes, doctors just don’t have the evidence to decide whether giving a certain treatment to an older person will benefit them, because trials of that treatment have excluded older people. And sometimes doctors might decide a patient is just ‘too old’ for a treatment, without really thinking about that patient’s individual circumstances – focusing on their chronological, rather than biological, age.
Although it’s possible that some older patients are missing out on effective and appropriate treatment, overall, it seems that older patients are still more likely to have confidence in their doctors and nurses and to feel that they were treated with dignity and respect. But they are also less likely to say they were told about side effects of their treatment.
Lots of factors might explain why older people report a different experience of cancer care compared with younger people – different cancer types, a different outlook on ‘people in authority’, or different information needs. We need more research to understand these differences.
What can be done?
Of course age alone doesn’t define a person’s needs. These are also determined by the type of cancer they have, their level of social and economic deprivation, their sex, their ethnic group, and their general health apart from their cancer.
So a key message from the report is that understanding each older person’s unique circumstances is vital to providing the best support and care at every stage of their cancer journey.
But in his foreword, Sean Duffy homes in on several things that will improve that journey for older people:
- Support for lifestyle changes to reduce their risk of developing cancer and to make them fitter for more aggressive (but more effective) treatments
- Help in becoming more aware of possible cancer symptoms and encouragement to tell their GP if they have those symptoms
- Help doctors make cancer treatment decisions based on fitness for treatment and patient preference, not patient age
And he promises that ‘…actions to tailor services to the needs of older people [will be] at the heart of [NHS England’s] efforts to further improve all aspects of cancer services in the coming years’.
We’re behind him all the way.
Katrina Brown is a senior cancer epidemiologist at Cancer Research UK
- Download the report via the NCIN website