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In the second part of our series on old age and cancer, we look at how the NHS needs to adapt as the number of cancer cases diagnosed in older people is projected to rise.

Every year around 130,000 people aged 75 and over in the UK are told they have cancer. By 2035 this is projected to rise to around 234,000.

This means that in just under 20 years, almost half (46%) of people diagnosed with cancer each year in the UK will be over 75.

Cancer is primarily a disease of ageing. And as we age, we’re more likely to develop other health conditions too. This means older cancer patients often need extra support to get through treatment or to recover from it.

This added complexity of cancer care, alongside growing numbers of patients, points to a future where the NHS will need to adapt to provide this additional support and the best care possible.

The problem is the NHS is already under a lot of pressure, including facing severe staff shortages. And there’s the added challenge that older patients already tend to have poorer outcomes than their younger counterparts. If the UK is to give all cancer patients the best chance of survival, the NHS must focus on improving outcomes for older patients.

Our new report published today summarises the challenges facing the NHS as our population ages. It’s based on interviews and surveys with patients, health professionals and people who make decisions about NHS care. And the conclusions highlight how services must act to make sure they’re working well for older people with cancer now, and in the future.

What’s the problem?

Evidence shows that right now, UK cancer services aren’t doing as well as they should for older people with cancer.

Cancer survival is generally lower for older patients, even when taking into account other health conditions that older people may also have. The cancer survival gap between the UK and other similar countries is also worse for older patients than it is for younger patients.

And despite survival doubling over the past 40 years, the gap in survival between younger and older patients remains.

One explanation for this is that older patients are less likely to have several different types of treatment that could help them live longer.

Why are older patients not having as much treatment?

In some cases, patients might choose not to have intensive treatment, either because they’re not well enough or because they’re prioritising their independence and quality of life, rather than trying to extend their lives at any cost. That decision is up to each patient and their loved ones. But it raises the challenge of how to have complex conversations when consultation times and NHS staff are stretched.

But sometimes, the treatment people are offered isn’t based on a full assessment of how fit they are, how much support they need, or how well they will be able to cope with treatment. This means that sometimes older patients aren’t given the best possible treatment for them.

In contrast, from speaking to older people with cancer in our research, we heard that some feel under pressure by their doctors to have intense treatment, and don’t feel like their doctors give them enough information about the side effects they could face.

Mostly, it was assumed that I would do whatever they suggested […] I do not feel in hindsight that I was given much choice, or indeed support to make that choice

– Patient

The NHS needs to get the balance right. No two patients are the same, so cancer treatment and care plans should be shaped around each person’s individual situation – including their social and medical needs.

What’s the solution?

It can be difficult to make a busy health service a personalised one. And when staff are under so much pressure, it’s hard to find enough time for in-depth conversations about options. But it’s vital the NHS finds a way.

Today I had a patient who has cancer but has other comorbidities […] so I had to discuss that […] and make it clear to them that these are the risk factors, these are the things that go wrong […] that 20/30 minutes […] gets dragged on to 45 minutes. We can’t just stop the consultation because it’s been running out of time

– Anaesthetist

But there are ways that this process can be made easier. And we think it hinges on finding better ways of assessing older patients’ needs.

This was highlighted in the 2015 Cancer Strategy for England, which said that methods of assessing older patients weren’t fit for purpose, “resulting in older people’s needs not being identified or understood”.

In our research, we found that although doctors know that gauging frailty is important, very few places use the most comprehensive tests and assessments. We’d like to see this change.

These assessments help doctors predict how well a patient will cope with treatment, and the support they might need. They should be used consistently for everyone. That’s why we want health services to roll these out across UK cancer services. And we’ll be exploring how research might help improve assessments in the next post in this series.

The NHS must also make sure patients receive the support they and their loved ones need to get through treatment and recover from it.

It’s one thing to choose to decline treatment, because the effort of chemotherapy and how ill it’s going to make you feel isn’t worth (it) […] It’s very different to making a decision based on ‘I can’t get the care for my husband or I can’t get the care for my wife or I don’t have transport to get to the chemotherapy […] or I’ll feel too rubbish afterwards and there’s nobody around to do my cooking and cleaning’

– National interviewee

There are also ways to help make sure cancer teams have enough time to discuss complicated cases in depth, by making the multidisciplinary team meetings (MDTs) more efficient and effective.

One of the issues for all MDTs is managing to comprehensively get through the cases in a meaningful way in which we [healthcare professionals] make the right selection of treatment strategies when you’ve maybe got […] forty patients plus at an MDT

– Clinical oncologist

Fundamental to all of this is information, which needs to be shared more effectively. This means sharing information between GPs, doctors and cancer teams. But perhaps most importantly, it means sharing information with patients, to help support discussions and decisions.

This isn’t easy, and there are lots of different groups involved. So, to make all of this happen, and to do it well, the NHS needs more staff.

For 70 years, the NHS has been at the forefront of fighting cancer. But it needs more investment in staff. And while it’s great that there’s now extra funding, this falls short of what’s needed to transform how patients of all ages are cared for.

If the Government is serious about its bold ambitions for improving cancer survival and care, this needs to change. And older patients need to be a part of it.

Rose Gray is a policy manager at Cancer Research UK

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Comments

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Maura O'Flynn July 21, 2018

The NHS is under such unbelievable pressure and everyone in the medical field is doing such a fantastic job in helping the patients in their patience and kindness towards everyone. We need extra funding and I feel that the patients who can afford to maybe could help by paying a little towards their treatment.

John Farnworth July 21, 2018

I’d like to think that a lot of people the the NHS has helped survive cancer would at least leave a benefit of there will,when the time arises to depart from this world.I do appreciate not everyone is in that position but those that can should perhaps that could boost cancer research funds.

Sue doyle July 21, 2018

As a cancer patient I would agree I also would like to be involved in MDT meetings that involve my care as with everything else by the time I get any test results these have already been discussed and my care decided without me knowing the outcome until I have an app which sometimes can be weeks after test ?

Mrs irene morley July 21, 2018

We need to train Drs for when we first begin going to them .’re breathing pains lose of weight extrem tiredness.i was going over a year. Given that many different inhalers it was untrue.tablets for chest Infection 5 times.nibulizer 4 times .still never sent for x-ray.ashma nurse called Dr into her room 3 times .it was her that ASK the Dr to send me for a x-ray.he was not to happy about it but agreed. The nurse got me appointment right away .and then it all began pet scan etc with in 4 weeks on was In broad green having major surgery. To have part of my lung removed ‘re cancer . no support on coming out.was rushed back into hospital 6 times in the 7 months very I’ll. All I received was a few phones calls .

Mary sinclair July 21, 2018

I’ve had cancer and the NHS saved me. We need the men and women who treat and look after us .

Amanda Carroll July 21, 2018

My mother got ovarian cancer stage 3/4 when she was 76 and survived it until aged 81.. if you need me to sign a petition that goes to the government.. please submit and I’ll be more than happy to sign it.. thank you for your very informative emails and all the absolutely wonderful work you continue to do xx

George French July 20, 2018

My wife died of a late diagnosed lung cancer aged 70. Despite type 2 diabetes she was otherwise healthy and active and had never smoked. . She had been seeing her usual GP regularly and over the course of a year had complained of various shoulder, neck and pelvic pains, tiredness and breathlessness. She had also had long term cough but there was no record of this in her notes. She was treated with a targeted medication and was not given any choice of surgery or general chaemo. the cancer was in one lobe of her lungs and there was no definite proof of a spread . Despite initial improvement and few side effects she took a turn for the worse after about four and half months and died a few weeks later while awaiting approval for a drug trial. Her death raised several concerns for me: Because she was non smoker I think lung cancer was not considered. her usual GP was relying on blood tests which told her “something was going on” but she was not allowed to send her for a general body scan to find out what. The problem was identified by another GP who simply tapped her back (old fashioned medicine?) and send her straight for an X ray.. 4 days later she was admitted from the surgery by ambulance as an emergency to have 2 L of fluid drained from her lung. We were not offered any surgical or general chaemo options and were too stunned to ask or challenge anything. Cancer is a mutation and it seems to me that reliance on a targeted treatment for one cell type, however initially effective, does not preclude further mutations which might have been prevented by a more general radio or chaemotherapy. Maybe over reliance on blood tests, ignoring basic diagnostic tools and X rays and apparently not being able to request full body scans where something is suspected led to an unnecessary early death.

Adrianne July 20, 2018

I think that possibly more staff are needed to help older people when they have had treatment and through their recovery time, however long it takes. Not just carers but people who also have knowledge and training with dealing with cancer. I know personally, that without the help of my family, partner, and son, I would not have coped well alone., and I don’t consider myself to be old. Older people who live alone would struggle to cope with feeding themselves,shopping, and also washing shopping etc. Defiantly need help, and in knowing help is available to them would make a person feel that they can accept treatment treatmentknowing helps available.

Stuart Sutton July 20, 2018

I am currently receiving treatment for prostate cancer, and have been doing so for the past five years. The NHS has been nothing short of brilliant in the handling of my case, and continue to be so. The staff are friendly and put one at ease(I am eighty-two). I have had no trouble so far in acquiring such medication as is required (apart from standing in a queue to obtain it), and I feel that I am ticking along nicely. I know that I can’t be cured, but, so far, it has not stopped my normal activities – I am a walker and progress some 1500 / 1700 miles a year, so very well done the NHS, and the STAMPEDE Cancer Research trials for keeping me on the go.

Katherine Wright July 20, 2018

In my experience the NHS approach to cancer care needs a radical overhaul regardless of the age of it’s victims. Bullying, browbeating and emotional blackmail to co-erce patients into accepting treatment coupled with a lack of information seems to be the norm. It now appears that the get out clause for poor performance is lack of staff, or lack of funds when in reality poor communication skills and insufficient training must also play a part. The NHS has had a ‘one size fits all’ mentality for years and that has to change, there is no doubt that the NHS has done incredible things over the years but it has become old and out dated.

Sam Dearing July 20, 2018

I am a baby boomer. Went to school, class sizes had doubled. Jobs were plentiful.I was never unemployed. Governments of all parties have never made any provision for the need for housing, schooling, and infrastructure. it was all a reaction. Now wwe have an ageing population the result is the same. TheGovernment seems preoccupied with Austerity, and the results have now become into full blown crisis in all services. Particularly the health service. There was 60 years notice this was going to happen.
Only God and the dedication of the Workers in the NHS, and other services has saved us from a complete collapse. God help us all, we are not dying fast enough.

Martin July 19, 2018

I agree with Tony, & I’ll keep up my donations, my friends have been helped by caring and sensative treatments. Thank you all for helping

Tony Thouless July 19, 2018

I agree any improvements to cancer care is great if a bit slow.
One area I come across on a regular basis is after care, patients that have had successful treatment and are very grateful for the care they received feel that when you are given the “all clear” and need no further treatment you leave the hospital feeling over the moon, but it soon becomes a feeling of what has my life got in store.
You cant stop your mind working and cancer is always with you it’s such a strong word that whatever people say can never be forgotten.
I felt worried and alone for a long time before seeking help and it caused a lot of stress.
I feel that the hospitals should offer back-up referrals perhaps every two years to patients just to put their minds at rest, just a 10 minute consultation once in a while could mean so much to a patient and their family.

Tony July 19, 2018

A very good article.
I shall continue with my Monthly Donations

Peter desmier July 19, 2018

Very very good

Sue Crofts July 18, 2018

My mother died recently aged 91. Prior to her death she developed a type of blood cancer. I just want to say that the treatment she received on the NHS was excellent and helped to extend her life for a while. I agree with the sentiment expressed in the earlier article but wanted to give an example how good care was not rationed due to age and other health problems she had.

David wright July 18, 2018

Interesting

Russell Spencer July 18, 2018

This is my second comment. I have recently had Papylon treatment at Clatterbridge Hospital on the Wirral.
What an excellent place, the staff are so fantastic & the treatment is excellent.
I am 80 years old with unfortunately other ailments but the treatment I have had has been brilliant. So Thank you NHS & I sincerely hope that you get more support from the government than is currently offerred

Russell Spencer July 18, 2018

What an excellent article, thank you, but I cannot fully accept the statement that cancer is age related, I know a lot of younger people with or have had cancer. Babies & children also diagnosed.

Anne Lanes July 18, 2018

Yes it sounds like a good idea to carry out multidisciplinary assessments on older patients, but I worry that with the current waiting periods, following this route will only delay any agreed treatment. I am 76 and my husband is 81 and we get quite despondent as a result of the negativity around the NHS these days. Well done to Cancer Research UK – keep up the good work, we are very pleased to be a supporter.

Susan scofield July 18, 2018

I am an older patient with cancer and I have an appointment today I have to travel a long way for the appointment and often see a doctor for just a couple of minutes and nothing is resolved but I am just grateful for the treatment that I have had and I am over three score and ten and I think the focus should be on the young

Sara Shepperson June 21, 2018

A very sensitively written and clear assessment.