Older People Are Not Getting Proper Cancer Care

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.

“There is increasing evidence from around the world that elderly patients are being ‘undertreated’, leading to a ‘survival gap’ between older and younger patients,” he writes.
“Our current practices are essentially ageist, as we are making judgements based on how old the patient is rather than on their capacity to be entered into clinical trials or to receive potentially curative therapy.”

The evidence:

*A high proportion of older women with a certain form of breast cancer (‘triple negative’) receive less chemotherapy than their younger counterparts — despite evidence of the treatment’s efficacy in this patient cohort.

*More than 70 per cent of deaths caused by prostate cancer occur in men aged over 75 years, who usually have more aggressive disease. Few older patients, however, receive treatment for localised prostate cancer, and in most cases they are denied access to chemotherapy for advanced disease.

*Colorectal cancer is another disease of older people, yet the evidence again suggests that optimal treatment is not being provided to this patient cohort.”

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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.”

Bryant doesn’t believe there’s overt rationing when treatment decisions are being made.

“It’s a balance in the clinician’s mind,” she explains. “‘What is this treatment likely to offer in terms of individual survival?’ Maybe it extends life for two months but the chance of toxicity is great. It might weigh differently if the patient is 60 or 80.”

One of the problems, she says, is that, because older people are rarely enrolled in clinical trials, “we don’t have good evidence on the impact of chemotherapy or radiotherapy on older patients. We know it works on people age 50 to 59 because that’s who we have in the trials.”

 

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.”

But Globerman believes every Canadian of any age should receive optimal treatment.

“Two main tenets of the Canada Health Act are universality and accessibility,” he says. “You can’t have that in the act and not deliver it on the ground. Elderly people should receive the treatment and care they need based on their presenting symptoms. Surely our GDP is large enough to provide quality health care to elderly Canadians.”

Lawler, in his BMJ editorial about cancer care for the elderly, identifies international associations that are “recommending clinical trials should be without an upper age limit.”

He insists, “We need a fundamental change in cancer policy for the elderly patient.”

In the meantime, Bryant advises elderly patients or their family members to ask the doctor, if they’re interested in more aggressive treatment, “Are there treatment options that you would offer to me if I were 55 that you haven’t mentioned?”

Globerman says we have to demand more transparency in treatment decisions for the elderly. “And I can tell you one more thing,” he says. “Boomers are not going to put with this nonsense as they age.”

He sums it up this way: “Nobody lives forever, but if you’re 90-years-old and you need treatment that you don’t receive, for sure you’re not going to make it to 91.”

Have you experienced ageism when it comes to getting proper health care? Let us know in the comments!