Britain is failing to care for older people with cancer | Ciarán Devane:
Older people diagnosed with cancer are being under treated because of their age. This is discrimination and must stop
For some, age is just a number. But for older cancer patients it can be a very serious barrier to the best – and most appropriate – treatment. While cancer mortality rates are improving significantly for people under 75, the rate is much slower in the older population. In fact cancer mortality is actually getting worse for people aged 85 and over – as a result, there are about 14,000 avoidable cancer deaths in patients over 75 in the UK each year.
There is mounting evidence to show that older people are being under treated. They are less likely to receive surgery, radiotherapy and chemotherapy than young people and
Macmillan Cancer Support is concerned that treatment decisions are too often based on age, not on a patient's overall fitness. A
recent Department of Health study for instance found that age was a significant factor in determining treatment recommendations. People are being looked at just as a number, rather than an individual. We would not allow people to be refused treatment for a life-threatening disease just based on their gender. Or their race. Why should age be your one determining factor?
Macmillan's own research highlights examples when patients have been told their age is the reason for them not receiving treatment. I have heard from a 67-year-old man who was told, when offered treatment options, that if he were 70 or over, it would be unlikely his doctor would offer surgery. There was no assessment of his health or fitness levels – his age was the only thing the doctor took into account.
Similarly, I know of a lady who wasn't encouraged to have chemotherapy purely because she was "60, not 30". People are still running marathons aged 60 and beyond – should they not be given the best chance against a fatal disease?
This situation isn't unique to the UK. But countries such as France and the US have been tackling this issue for more than a decade. We're only just waking up to it.
Older people can often tolerate and benefit from the same treatments as younger patients, but in many cases they simply aren't offered it. Cancer treatments can have unpleasant side-effects at any age. Yet there is a reason for this – it is killing off the cancer inside their bodies. We can't make assumptions about how well someone will cope with a particular treatment just because of their age. Is it because we assume that because someone is 70, 80 or 90, they're not going to live much longer? One 70-year-old may have another 10 years of good quality life ahead of them, another just a few years. This is why we need to treat older people as individuals.
The problem is, the current method of assessing older people for treatment is simply not right. Treating patients where there is no long-term gain is just as undesirable. What we need are fuller assessments of older patients to ensure they get the most appropriate treatment for their cancer.
Admittedly, there are other things affecting older people that can contribute to poor survival rates among this age group – by the time people are in their 80s, for instance, they can be suffering from several conditions. Yet co-existing health problems are often not understood by cancer specialists and are not effectively managed. On some occasions, people could be made well enough for treatment but aren't.
A side-effect of a drug for a different condition is sometimes seen as a reason to deny an older patient chemotherapy. But just a simple conversation between a patient and a specialist would have avoided the mistake.
Another obstacle older people face is that they are not represented enough on clinical trials. Clinicians, therefore, just don't know what impact a treatment will have – whether it will save or risk the patient's life. We want older cancer patients to be better represented on these trials.
Sometimes it's not that older patients are denied treatment – often they reject it, thinking it's not possible. They may have a spouse to care for at home or not be able to get to the hospital on their own. These things can be easily solved but elderly patients often don't know they can ask for practical support.
This issue has been brushed under the carpet for long enough. Our population is aging and, as the number of people diagnosed with cancer is creeping up, it is vital we ensure everyone gets the correct treatment.
The last decade has seen dramatic improvements in cancer treatment and services, but we must not ignore the fact that older people with cancer are not being treated fairly. They still have the worst chance of beating this disease. It simply isn't fair and is an act of discrimination that would not be allowed in any other sector of society.
This is why Macmillan has launched its
Age Old Excuse campaign – someone needs to bring these issues to light. The NHS and social care providers must wake up to the specific issues older people face and ensure treatment decisions are based on their overall health – not their date of birth.
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