Doctor's View Archive
Cancer Care ... Equal for All?
Older
people do not receive the same quality of cancer care as
younger people. Although more than a third of cancer occurs in people
over 75 years of age, their tumors are less fully diagnosed and less
fully treated than younger patients. This need not be the case as
some older people can tolerate chemotherapy, surgery and radiotherapy
just as well as younger patients, say Dr. Nicola Turner and
colleagues in the July 31 issue of the British Medical Journal.
In a study of the Yorkshire Cancer Registry covering close to 4
million people, the authors found that older patients had fewer
diagnostic and staging procedures and less treatment with advancing
age and that survival rates specific to the types of cancer declined
with age. They had fewer biopsies to confirm the tumor. With a given
type of tumor, the elderly thus received less care and survived a
shorter time.
Many clinical cancer trials have had arbitrary upper age limits.
Even clinical trials done in allegedly elderly subjects tend to
start at age 65. Very few studies include significant numbers of
people who are considered "old" (over 75) or "very old" (over 85).
The role and the effectiveness of many cancer treatments are
therefore not based on good scientific evidence in those most likely
to be affected by cancer: the elderly.
The reduced levels of intervention in cancer in the elderly can
not be wholly explained by appropriate adjustments for frailty or
comorbidity (coexisting diseases). Dr. Turner and her team suggest
that a factor contributing to this situation is ageism,
discrimination against the elderly.
Ageism may account for the common attitude that asks: why
intervene if an older man or woman with cancer does not have long to
live anyway? However, the facts are that a 75-year-old man and woman
in the U.K. have life expectancies of 8.5 and 11.1 years respectively
and the authors suggest that this should not be overlooked by
patients, their families or the healthcare staff.
Source: Turner NJ, Haward RA, Mulley GP, Selby PJ: Cancer in old
age-is it adequately investigated and treated? BMJ 319: 309-312,
1999.
Last Editorial Review: 7/7/2004
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