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’ -
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.
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
"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
"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
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
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
“The way quality measures are
defined has important implications for how care is delivered,” says lead
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
“If quality measures focused on age
and health status, rather than age alone, we’d have better outcomes,” he
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.