Older People Are Not Getting Proper Cancer Care
“Older people globally are being denied proper access to cancer care.”
Read that again. Think about it.
Shocking statement, isn’t it?
At the same time, not so shocking.
Ageism in medical care is familiar to anyone who’s had elderly parents with cancer or other life threatening illnesses.
But that statement isn’t based on anecdote or advocates for elderly patients.
It’s an editorial in the latest British Medical Journal titled ‘Ageism In Cancer Care: We Need to Change The Mindset’.’ It’s by Mark Lawler, professor at the Centre for Cancer Research and Cell Biology at Belfast’s Queen’s University.
What about in Canada?
“Certainly we know that’s happening in Canada,” says Dr. Heather Bryant, Vice President, Cancer Control at Canadian Partnership Against Cancer, about the discrepancies in cancer care for older people. “People over 70 are not getting served (with chemo and radiation treatment) in the same proportion as younger people.”
An example: chemotherapy treatment for patients with Stage 3 colon cancer.
Following surgery, 80 per cent of those age 60-69 receive chemo, 55-60 per cent of those age 70 to 79 and only 20 per cent of those 80 and over.
“We don’t know whether it was offered to older people and rejected or whether it wasn’t offered,” she explains, “but what happens after surgery is very age dependent. Is it because when people are older they are more likely to have other disease conditions, or are less likely to withstand therapy? We don’t know.”
There’s a movement afoot to bring more older people into clinical trials for cancer treatment, she says. “About 40 per cent of cancers in Canada are diagnosed in people over 70. We do need to recognize that we have to start getting good quality information on what cancer treatment does for people in that age group.”
Lawler, however, points out in his editorial that we already know enough to stop letting age dictate treatment in many cases.
‘‘It is disappointing that we see different principles being applied for older patients when compared to younger patients,” Lawler concludes, “with these differences leading to poorer outcomes in the elderly patient population.”
Ottawa resident David Globerman, 62, would use a stronger term than “disappointing” for the difference in medical care for older people with life-threatening illness.
He started the Running To Daylight Foundation 17 years ago when he realized his elderly father was not being given optimal care in hospital because of his age.
After his mother suffered a stroke and died from its complications in November at the age of 92, he found that treatment of the elderly had not changed in almost two decades. “We were getting pressure from the hospital not to feed her,” he recalls. “They asked, ‘Would your mother really want to live like this?’
He’s convinced there is rationing of care, with the elderly seen as a burden on the system as they approach the end of life.
“They don’t say explicitly that they don’t want to give treatment to the elderly because of age,” he says, “but there’s pressure on the family. The issue of scarce resources is there. It’s behind how hospital staff are making decisions.”
Bryant, a physician and epidemiologist, acknowledges that allocating resources is part of treatment decisions.
While she won’t call it rationing, she does refer to making decisions that are “cost-effective.” She says, “We’re better off investing in benefits across the board” instead of when “the benefit is small.”