Older people's pilot

Spring 2011 

Exploring new approaches to clinical assessment and supporting people with cancer.

In England, there are around 15,000 avoidable deaths^[1] from cancer each year in people over 75, and cancer mortality rates in this age group aren’t declining as rapidly as in the younger population. This can largely be attributed to late diagnosis and under-treatment.

Macmillan is working with the Department of Health| and Age UK| to address under-treatment of older people with cancer. In May, a number of pilot sites throughout England will begin to test new models of care for older people, including: 

- testing new clinical assessment methods  

- coordinating and delivering short-term practical support packages for those undergoing treatment  

- promoting age equality to address discriminatory behaviour in cancer services.

Assessment methods

Two older people with cancer may be the same chronological age but have different physiological ages. One older person interviewed for the recent Macmillan Walking into the Unknown report said: ‘I asked my specialist nurse about the decision on my treatment to have the injections. She brought my file in and showed me a letter that had been signed by four consultants. It said that “due to the patient being 85 we recommend hormone treatment”. 

‘I’m sure if I was 65 I’d be on a different treatment. I’ve always been really active; I’m not necessarily a typical 85-year-old. 

‘It was like she was giving the game away, and it was at that point that I thought for the first time “this is palliative” not curative.’ 

Half of all cancers occur in people aged 70 or over. In the case of some older people with cancer, curative treatment won’t increase the quality or length of their life, and may be harmful. As such, older people commonly receive less aggressive therapies. 

We hope that assessment methods routinely used in older people’s medicine will be adopted into cancer services. This may lead to identifying more older people for whom curative treatment would be appropriate, and reduce the number of people denied treatment based on their chronological age.

Practical support

By coordinating and delivering short-term practical support pilot sites, our aim is to reduce the number of older people who won’t accept cancer treatment because they don’t feel they’ll be able to maintain their independence and cope as a consequence. Practical support may include activities such as providing transport, housekeeping, shopping, and befriending. 

Dr Winnie Kwan, a South London Macmillan GP involved in the pilot says: ‘Older people with cancer can be particularly vulnerable. It’s crucial that GPs have increased knowledge of each patient’s circumstances and work more closely with oncologists to deliver holistic assessment and coordinated care.’  

The pilot will see greater collaboration between services and the voluntary sector to ensure that older people receive the support they need. We have more information about the pilot|.

Our five pilot sites

- Sussex Cancer Network

- Thames Valley Cancer Network  

- Merseyside and Cheshire Network  

- North East London Cancer Network  

- South East London Cancer Network

Further information

Email Hazel Brodie|, Macmillan Older People’s Pilot Project Manager.

Read more about the Age old excuse campaign|.

References

1. Report of the All Party Parliamentary Group on Cancer’s Inquiry into Inequalities in Cancer| [PDF, 539kb].