The Age Old Excuse – how older cancer patients are still being under treated


A new report (pdf) from Macmillan Cancer Support today shows older cancer patients continue to be under-treated – often with devastating consequences.

Percentage-of-patients-receiving-a-major-resection-by-age-and-cancer-site
The report warns:

Cancer is a disease of age – half of all new cases of cancer in the UK are in people aged 70 or over. Worryingly, we have some of the worst survival rates in Europe for older people.

Our mortality rates are also higher than the US. More than 14,000 cancer deaths in the UK in the over 75s would be avoided each year if our rates were the same as the USA.


As Macmillan’s “Age Old Excuse” campaign says:

We all have different needs and older people are no exception. Some are frail, whilst others are fit and active. Regardless of age, everyone should get the treatment that’s right for them.

Adding:

We’re concerned that the UK has some of the worst survival rates in Europe for older people. Although late presentation and diagnosis plays a part, there is a growing body of evidence to suggest that older people with cancer are under-treated.

This may explain why, while mortality rates are improving significantly for the under-75s, they are improving at a much slower rate in those aged 74-84 and actually getting worse for those aged 85 and over.

A Macmillan/ICM poll in this morning’s Telegraph highlights the problem of too many elderly patients being ‘written off’ as “too old for treatment” as a result of widespread ageism in the NHS:

About half of those surveyed (48 per cent) said they thought “stereotypes and assumptions” about older people were resulting in some patients not getting the best treatment for cancer.

A similar proportion (45 per cent) said they had dealt with a cancer patient who had been refused treatment on the grounds of age.

And two-thirds (67 per cent) said they had heard other health workers speaking to older cancer patients in a “condescending or dismissive way”.

The problem is nothing new – and yet nothing seems to change. In March, Macmillan Cancer Support’s older people’s expert, Hazel Brodie, wrote about the issue for the BBC, using almost identical arguments to those deployed today – arguments that, unless there is real change in our NHS, are bound to be repeated time and again.

She said:

“Research we have done shows older people are less likely to receive surgery, radiotherapy and chemotherapy than their younger counterparts. This difference in treatment rates cannot be entirely accounted for by medically justifiable reasons such as the presence of untreatable co-morbidities. We are deeply concerned that treatment decisions are too often being made on the basis of age, regardless of how fit patients may be, leading to under-treatment.

“The older population is a varied one. One 85-year-old may tolerate chemotherapy well, while another may experience complications such as severe toxicity. Similarly, one 78-year-old may be bed-bound, while another may participate in half marathons. As such, older people must be treated as individuals.

“Clinicians require more information on frailty in order to make appropriate treatment recommendations which is why we are calling for more effective assessments to be used to indicate who will tolerate what treatment.

“Inadequate practical support to help older people at home, with transport, or with care for dependent spouses and other family presents another barrier to treatment. We have heard of older people having to turn down treatment because of this.

“Time and time again I hear older people recounting the difficulties they have in getting to and from hospital for their treatment or with meal preparation and shopping.

“One 81-year-old said:

“I didn’t have chemotherapy, because they thought if I couldn’t get to hospital to have it, it wasn’t much good. They didn’t say that they would provide transport for me.”

“This is simply unacceptable.

“Patients should be provided with information about local services which can offer practical and social support during cancer treatment. An older person should never refuse treatment because they’re having difficulties with transport or caring for a relative.

Age discriminatory practices are also a barrier to older people getting the treatment. Britain is one of the worst in Europe for negative attitudes to the elderly. A recent survey undertaken by the British Geriatric Society showed that one third of geriatricians believed that the NHS was ‘institutionally ageist.

“We want “age equality” within cancer services. Older people are all individuals with differing levels of frailty, mental attitude, and support. Each will tolerate cancer treatment differently. It is vital that steps are taken to ensure that the right people get the right treatment at the correct level of intensity, together with the practical support to enable them to take up and complete the treatment.

Writing people off as too old for treatment is utterly shameful.

For more on the campaign, see www.macmillan.org.uk/ageoldexcuse and check out this video:

Just as there is no such thing as the typical young person, or woman, or man, or baby, so there is no one type of ‘old person’. They are all, as are we all, individuals, and in the case of older patients, have paid taxes all their working lives to fund the NHS for all our benefit, and should, nay must, be given the best treatment possible, without exception and without delay.

See also:

Survival rates for the rarer cancers continue to trail behindOctober 24th, 2012

We need to save the Cancer Networks: NHS strategy is not bureaucracyOctober 6th, 2012

When I Die: Lessons from the Death Zone – Philip GouldApril 20th, 2012

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