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Health & Medicine for Senior Citizens

Senior Citizens Being Denied Proper Access to Cancer Care; Evidence, Protests Growing

We need a fundamental change in cancer policy for the elderly patient, says editorial in British Medical Journal; U.S. VA study finds fault with ‘simple age cut-offs’ - see video

Joel, 75, talks about his experience as a colon cancer patient. He was surprised when cancer was discovered through routine colorectal screening. Screening is recommended every ten years through age 75. Click to Video

March 11, 2014 – There is growing evidence and an increasing outcry that senior citizens may be suffering and dying just because testing or treatment that could save their lives is denied strictly on the basis of their age. An editorial in the British Medical Journal (BMJ) says older people around the world are being denied proper access to cancer care. A new U.S. study finds a “simple age cut-off” is not the answer in screening for colorectal cancer.

"There is increasing evidence from around the world that elderly patients are being 'undertreated', leading to a 'survival gap' between older and younger patients,” writes Professor Mark Lawler of the Centre for Cancer Research and Cell Biology, Queen's University, in the BMJ editorial.

"We need a fundamental change in cancer policy for the elderly patient. Our current practices are essentially ageist, as we are making judgments based on how old the patient is rather than on their capacity to be entered into clinical trials or to receive potentially curative therapy,” he writes.

“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."

In the editorial entitled, Ageism in Cancer Care: We Need to Change the Mindset, he cites 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.

Future patient-centered quality measures should focus on clinical benefit rather than age to ensure that patients who are likely to benefit from screening receive it, regardless of age.

The editorial, co-authored by UK cancer experts, Professor Peter Selby and Sean Duffy (National Cancer Director NHS England), and Swiss oncologist and member of the executive of the International Society for Geriatric Oncology, Matti Aapro. also points to specific situations in that report.

A high proportion of older women with a certain form of breast cancer ('triple negative') receive less chemotherapy than their younger counterparts - despite evidence of the treatment’s efficacy in this patient cohort, the authors claim.

They also point out 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 localized prostate cancer, and in most cases they are denied access to chemotherapy for advanced disease, they add.


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Why Do They Keep Screening 75-Year-Olds for Cancer When They Are Not Supposed To?

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Most Older Men Say They Want Prostate Cancer Test Despite Risks, Task Force Objections

Although experts say middle-aged men should not have routine PSA tests, majority of older men disagree, especially those of higher income, black or had recent test

By Valerie DeBenedette, HBNS Contributing Writer

July 11, 2013


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

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.

In the US, the number of senior citizens – age 65 and older - is set to double at least, from around 40 million in 2009 to 89 million in 2050. Cancer is mainly a disease of the elderly. Given our ageing demographic, the paper argues, this will lead to an exponential increase in the number of cancer deaths unless we change our approach towards the elderly cancer patient.

Veterans Administration study

The Veterans Administration, the nation’s largest integrated health system, Medicare and many private insurers use quality measures to encourage screening among 50- to 75-year-olds. But the use of simple age cut-offs in these quality measures may contribute to what researchers found was underuse of screening in healthy, older people and overuse in unhealthy, older people.

This study by investigators at the University of Michigan and the Veterans Affairs Center for Clinical Management Research used 2010 data on 399,067 VA enrollees.

An unhealthy, 75-year-old – whose life expectancy is estimated at less than five years – was significantly more likely to undergo screening than a 76-year-old who’s in good health, according to the study published in BMJ.

“The way quality measures are defined has important implications for how care is delivered,” says lead study author Sameer Saini, M.D., a research scientist at VA-CCMR and assistant professor of internal medicine at the U-M Health System.  “By focusing on age alone we’re not screening everyone who’s likely to benefit and some people who are not likely to benefit are being screened unnecessarily, like those with severe health problems.

“If quality measures focused on age and health status, rather than age alone, we’d have better outcomes,” he adds.

In elderly patients, life expectancy varies considerably according to health status. For instance, a 74-year-old man who is in excellent health has a life expectancy of almost 15 years.

The study suggests the upper age cut-off could unintentionally discourage screening for these healthy, older individuals, leading them to miss out on the colorectal screenings known to prevent cancer. CRC screening tests include colonoscopy, sigmoidoscopy, and fecal occult blood testing.

“Future patient-centered quality measures should focus on clinical benefit rather than age to ensure that patients who are likely to benefit from screening receive it, regardless of age, and that those who are likely to incur harm are spared unnecessary and costly care,” says senior study author Eve Kerr, M.D., M.P.H., director of VA-CCMR and professor of internal medicine at the U-M Health System.  

Both authors are members of the Institute for Healthcare Policy and Innovation.


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