26 March 2012
New report highlights issues contributing to the under treatment of older cancer patients
Under treatment is one of a number of factors contributing to around 14,000 avoidable cancer deaths in patients over 75 in the UK each year says a new report launched today by Macmillan Cancer Support.
While cancer 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 people aged 85 and over. This can be attributed to under treatment as well as late diagnosis and high incidence.
The number of people living with a cancer diagnosis is set to rise from two to four million in the next twenty years. With half of all new cases of cancer in the UK diagnosed in people aged 70 or over, this is an issue which must be addressed as a matter of urgency.
Macmillan’s new report, The Age Old Excuse: the under treatment of older cancer patients, highlights some of the reasons why older patients are less likely to receive treatment than younger patients. These include:
Recommendations on treatment are too often being made on the basis of age, regardless of how fit patients may be.
Assessments do not adequately measure an older person’s fitness for treatment, and co-existing health problems are often not identified or effectively managed.
Many patients do not take up treatment because they have inadequate practical support to help them at home, with transport, or with care for dependent spouses and other family.
Older people are not represented on enough clinical trials, reducing the amount of evidence available to clinicians on benefits and risks of cancer treatment and impact on quality of life.
Oncologists and cancer surgeons need more support to manage issues specific to older people such as falls, incontinence, and multi-drug use. In a survey of 98 oncology trainees, 60% reported that they have never received any training in the particular needs of older people with cancer, despite them making up half of numbers getting cancer each year.
Ciarán Devane, Chief Executive of Macmillan Cancer Support, says:
‘To deny older patients treatment that could cure them based on ill-founded assumptions is an unacceptable act of discrimination. We have a moral duty to treat people as individuals and give them the best chance of beating cancer, regardless of their age.
‘As our population ages, and the number of people diagnosed with cancer grows, 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.
‘Efforts are being made to increase early diagnosis and promote healthier lifestyles, but much more needs to be done to tackle under treatment. 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 just their date of birth. Writing people off as too old for treatment is utterly shameful.’
Professor Riccardo Audisio, Consultant Surgical Oncologist at St Helens Hospital, says:
‘It is despicable to neglect, not to offer, not to even go near to the best treatment option only on the simple basis of the patient’s age. This has been a horrible mistake that, particularly in the UK, we have suffered from.’
Geoff, 66, from Cleveland was diagnosed with prostate cancer last year. He says:
‘What surprised me most was a discussion about my treatment options. I was told as long as it’d not spread, surgery to remove the prostate would remove the tumour but if I were over 70, they’d likely not even be offering to operate.
‘Probably a view from the governing authority rather than the consultant but I found that to be discriminatory, and clearly ageist. I believe that the role of the medical profession is to prolong life, no matter what age. Surgery could give someone another 20 years.’
Macmillan is calling for a more effective way of assessing older people for treatment, more short-term practical support to enable them to take up recommended treatment and training for professionals working with older people within the NHS to promote age equality.
Macmillan, in partnership with Age UK and the Department of Health, has set up five pilots to test new models of older people’s care. They will report in December 2012.
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Notes to Editors:
A copy of Macmillan’s report – The Age Old Excuse: the under treatment of older cancer patients - is available here.
Macmillan’s Age Old Excuse campaign will run for at least a year. More information about the campaign is available at www.macmillan.org.uk/ageoldexcuse
 New research shows that under treatment is likely to contribute to the excess cancer deaths in patients over 75 in the UK. 14,000 cancer deaths in the over 75s could be avoided each year in the UK if mortality rates were the same as those in the USA
Moller H et al. High cancer mortality rates in the elderly in the UK. Cancer epidemiology.2011 http://www.ncbi.nlm.nih.gov/pubmed/21852216 (Accessed February 2012)
 National Cancer Intelligence Network (2010) Evidence to March 2010 on Cancer inequalities in England. http://www.ncin.org.uk/publications/reports/default.aspx (Accessed February 2012)
 Cancer Research UK. Cancer incidence by age - UK statistics [online] available at: http://info.cancerresearchuk.org/cancerstats/incidence/age/ [cited 01.11.11]
 Kalsi, T, Harari, D (2011). Geriatric Oncology training needs: A Survey of Oncology SpRs. Unpublished raw data
About Macmillan Cancer Support:
Macmillan Cancer Support improves the lives of people affected by cancer, providing practical, medical, emotional and financial support. Working alongside people affected by cancer, Macmillan works to improve cancer care. More than one in three of us get cancer. Two million of us are living with it. If you are affected by cancer Macmillan can help.