Academic calls for end to ageism in cancer care

Older people all over the world are being denied proper access to cancer care, according to a leading cancer academic.

Professor Mark Lawler of the Centre for Cancer Research and Cell Biology at Queen’s University in Belfast, Northern Ireland said in an editorial in the BMJ (British Medical Journal) that “there is increasing evidence from around the world that elderly patients are being ‘undertreated’, leading to a ‘survival gap’ between older and younger patients.”

He called for “a fundamental change in cancer policy for the elderly patient” and said: “Our current practices are essentially ageist, as we are making judgements based on how old the patient is rather than on their capacity to be entered into clinical trials or to receive potentially curative therapy.

“It is disappointing that we see different principles being applied for older patients when compared to younger patients, with these differences leading to poorer outcomes in the elderly patient population.”

Older women receive less chemotherapy than younger counterparts

A high proportion of older women with a certain form of breast cancer ('triple negative') receive less chemotherapy than their younger counterparts - despite evidence that the treatment is effective, according to Professor Lawler.

He revealed that more than 70 per cent of deaths caused by prostate cancer occur in men aged over 75 years, who usually have more aggressive disease. Few older patients, however, receive treatment for localised prostate cancer, and in most cases they are denied access to chemotherapy for advanced disease.

Professor Lawler's findings are published in an editorial in the BMJ entitled, 'Ageism In Cancer Care: We Need to Change The Mindset'. It states the need to redress the disparities in the policy on cancer for older patients, citing a recent position paper from the European Organisation for Research and Treatment of Cancer, the Alliance for Clinical Trials in Oncology and the International Society of Geriatric Oncology recommending that clinical trials should be without an upper age limit.

“Colorectal cancer is another disease of older people, yet the evidence again suggests that optimal treatment is not being provided to this patient cohort,” said Professor Lawler.

Cancer mainly disease of the elderly

Cancer is mainly a disease of the elderly and estimates for the UK suggest that 76 per cent of cancers in men and 70 per cent of cancers in women will occur in the over-65 population by 2030.

The EUROCARE 5 study claims that the survival gap was widening between older and younger patients in Europe.

Professor Lawler calls for an “urgent need” for a “geriacentric” strategy that maximises clinical trial activity in older patients, makes existing treatments more available and develops new approaches that are well tolerated in older people.

He said: “Such a strategy will also have to ensure that the principle of early diagnosis (underpinning more effective and less aggressive treatment) is applied in older patients as well as in their younger counterparts. Only then can we truly deliver a comprehensive cancer service to the elderly population in our society.”