Charity criticises cancer care for older people

Macmillan Cancer Support says cancer mortality rates for older people improving more slowly than for younger patients

Cancer mortality rates among older people are failing to match the improvements seen in younger patients, Macmillan Cancer Support warns today. Under-treatment and a failure to properly consider the effects of age are to blame, and if mortality rates for the over-75s were reduced to levels seen in the US there could be 14,000 fewer deaths a year, the charity said. It says doctors often give treatment plans purely based on a patient’s age, ignoring individual fitness levels; too few older patients are involved in clinical trials, and they often get insufficient support during debilitating treatment. Peter WalkerToo many older people with cancer are receiving insufficient or inappropriate treatment, with mortality rates for those in their mid-70s or over failing to match the improvements seen with younger patients, a leading cancer charity has warnedMON.

Macmillan Cancer Support cited factors including under-treatment and a failure to properly consider the effects of age, and said if mortality rates for the over-75s were reduced to levels seen in the US there could be 14,000 fewer deaths a year from cancer among that age group, said in a report, The Age Old Excuse.

Cancer mortality rates for people aged 74-84 in the UK are improving much more slowly than for younger patients, it said, and are rising for those aged 85 or greater. With half of all new cancer cases appearing in the over-70s, this was a major health issue, the charity said.

The report, The Age Old Excuse, warns that too often doctors give recommendations for treatment purely based on a patient’s age, ignoring individual levels of fitness, and that separate health problems relevant to the treatment are sometimes not properly identified or managed. This effect is magnified because too few older patients are involved in clinical trials, it says.

Separately, the report notes, some older cancer patients find it hard to take up potentially time-consuming or debilitating treatment as they might have insufficient support, for example with transport, or they are a carer for a spouse or another family member.

The charity recommends that oncologists and cancer surgeons gain better knowledge of the specific issues surrounding treatment to older people. A snapshot survey of 98 oncology trainees found 60% had not received any such training.

Ciarán Devane, the charity’s chief executive, said blanket age-based decisions on who should receive certain treatment amounted to “an unacceptable act of discrimination”.

Devane said: “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.

“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.”

As well as better training for doctors, the charity is calling for improved ways to assess the needs of older patients and more practical assistance to help them take up treatment,

Along with Age UK and the Department of Health, the charity is running five pilot schemes to try out new ways to treat older cancer patients, which will report at the end of the year.

The junior health minister Paul Burstow said NHS staff were working to ensure cancer patients of all ages received the best treatment possible. He added: “However, we are under no illusions that there are unjustifiable variation in standards, which is why we have funded five pilots jointly with Macmillan to help us understand how older people with cancer are cared for. The learning from the pilots will help the NHS to ensure that all older patients with cancer have their needs properly met.”