The world must urgently prepare for a global “tsunami” of millions of older cancer patients or risk healthcare systems being unable to cope, leading doctors have warned.
With life expectancy increasing and a rapidly soaring population of older people, a looming increase in elderly patients with cancer was now a “serious public health concern”, the American Society of Clinical Oncology (ASCO) said in a report. Cancer centres must prepare for “the silver oncologic tsunami”, the experts added.
At ASCO’s annual meeting in Chicago, the world’s largest cancer conference, Dr Andrew Chapman, the director of the Sidney Kimmel Cancer Center-Jefferson Health and a specialist in geriatric oncology, said: “As the population expands and the incidence goes way up, are we really prepared to deal with those needs? I think globally, we’re not prepared.”
Older age is a well-established risk factor for cancer but the importance of incorporating older-adult–specific assessments into cancer diagnosis, care and treatment has been under-recognised for years.
“We know cancer is a disease that is associated with ageing, and there are a number of biological mechanisms as to why that is,” Chapman said. “What is often times missed is that the older adults’ goals, wants, needs, preferences, and issues are much different than those of the average adult.
“Sometimes there’s a nihilism – ‘if you’re older we’re not going to bother’ – which is horrible,” he added.
Older patients often prioritise maintaining independence rather than seeking curative treatments, Chapman says. They care about being able to perform activities such as driving, spending time with family, and hobbies like golf and gardening, he added.
“If you’re going to give somebody treatment that’s going to take that away, they may not want it. Much different than somebody who’s 45 who wants to live for another 40 years,” he said.
Dr Julie Gralow, the chief medical officer and executive vice-president of ASCO, said healthcare systems should act immediately to avoid being overwhelmed by the dramatic rise in older cancer patients. “By 2040, the global burden is expected to grow to 27.5m new cancer cases and 16.3m cancer deaths simply due to the growth and ageing of the population.”
According to estimates from the International Agency for Research on Cancer (IARC), in 2018 there were 17 million new cancer cases and 9.5 million cancer deaths worldwide.
Workforce barriers such as a lack of widespread geriatric training and global staff shortages could make adopting models of care to better suit older patients even more challenging, Gralow said.
Diversifying clinical trials would also help, she added. “Most clinical trials data comes from younger patients – very few older patients are included. We need to include older patients in trials so that we can understand the toxicities and efficacies of therapies on this population.”
In the US, the National Cancer Institute projects that by 2040, nearly three quarters (73%) of people living with cancer will be over the age of 65.
In Britain, the number of people diagnosed with cancer will rise by a third by 2040, taking the number of new cases every year from 384,000 to 506,000 for the first time, according to analysis by Cancer Research UK. Most of those affected will be 70 or over – 60% of cases and 76% of deaths.
“There will be more elderly people with cancer diagnoses and of course they require multidisciplinary care,” said Prof Charles Swanton, Cancer Research UK’s chief clinician. “They often have comorbidities and other diseases like cardiovascular disease, heart or respiratory problems.”
Speaking in Chicago, Swanton said older patients were also more likely to be taking medicines for other ailments, making cancer treatment more complicated.
“The question is, ‘how is the health system going to cope with that?’ It’s a major concern when it comes to workforce planning. If we’re dealing with 30% more cancer diagnoses, and those cancer diagnoses are more complex, we’re going to need at least 30% more oncologists, surgeons and pathologists to cope with the caseload.”
Caroline Abrahams, the charity director at Age UK, said many elderly patients were “already waiting longer than they would like” for treatment.
