Cancer Care ... Equal for All?

Doctor's View Archive

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.

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