A lack of expertise in geriatric oncology means that cancer in older adults is often confused with other signs of ageing and diagnosed too late.  Dr Sonali Johnson sets out a blueprint for addressing this barrier – one of the many topics to be discussed at the World Cancer Congress, hosted by the Union for International Cancer Control in Geneva, 18-20 October.

Cancer is a disease for which older adults are particularly at risk as the cells of the body are more likely to turn cancerous as a person ages, primarily as a result of greater exposure to risk factors (though this exposure can be reduced by adopting early a healthy lifestyle). In 2020, over 50% of all cancer cases were among people aged over 65 – nearly 10 million out of a total of 19.3 million – and this proportion will grow further in the coming decades, with the fastest increase occurring in low and middle-income countries (LMICs).

The treatment of cancer is more complex for older adults with co-morbidities, requiring an integrated approach. Yet a lack of expertise in geriatric oncology at different levels of the health system means that cancer in older adults is often diagnosed late as early symptoms are sometimes considered to be signs of ageing. Cancer is more complicated and invasive to treat successfully when it is detected at a more advanced stage.

Age isn’t everything

Older adults are not a uniform group and age alone is a poor predictor of an individual’s health. They can have widely varying physical and mental health at a similar age, with the presence or not of co-morbidities. They may or may not have a strong social support network. They may have considerable or, on the contrary, very limited financial means. Each of these factors will shape if and how an older adult engages with the health system, therefore their preferences and needs should be individually assessed. 

To do so effectively, we need to improve our data on the prevalence of co-morbidities amongst adults aged over 65. Many health policies have been developed and implemented with partial information and in silos, addressing diseases separately. There is an opportunity here for cross-sectoral and multisectoral coordination and integrated approaches that lay the groundwork for patient-centred care.

There is also a need to train health staff in geriatric care to correct the misconceptions that often surround health and ageing – stereotypes, assumptions and prejudices that mask the diverse nature of older populations and the contributions of older adults to society.

Patient-centred care also means removing age limits in clinical trials and the inherent biases in research programmes to make them more inclusive. Currently, doctors and regulators may have little precise knowledge of how older adults react to certain treatments or how cancer medicines may interact with other medications they are taking, since these have not been tested.

Countering misperceptions that older adults themselves may have about clinical trials (e.g. fear of mistreatment, being used as a ‘guinea pig’) is also essential to improve access to services and research. Other limitations also need to be addressed, such as hearing or transportation difficulties.

Only if older adults are proportionately well represented in clinical trials and research can doctors have more insight into the efficiency and side effects of cancer treatments for people over 65.

Caring for older cancer patients is a surmountable challenge

The Union for International Cancer Control (UICC) has made cancer and ageing a focus area of its work, supporting the advocacy efforts of UICC member organisations in LMICs working to improve access to cancer services and care for older adults

Initiatives in El Salvador, Guatemala, Kenya, Mongolia and Tajikistan have been set up in partnership with Sanofi, to improve the training of healthcare practitioners in geriatric care; include cancer and ageing strategies in national cancer control plans and universal healthcare packages; ensure cost-free access to cancer medicines for people aged over 65, and increase the availability of palliative care specifically tailored to the needs of older adults.

To improve cancer care for older adults at the international level, the International Society of Geriatric Oncology has developed the Top Priorities Initiative to identify global priorities for progress and development in geriatric oncology and translate these priorities into tangible actions.

The American Society of Clinical Oncology (ASCO) has issued recommendations for geriatric assessments, a tool to understand an older person’s physiological and socioeconomic situation to inform the most effective and appropriate course of care.

These are being adopted by several health systems, for instance in Chile, where the Arturo Lopez Perez Foundation (FALP) created an oncogeriatric unit to provide a comprehensive geriatric assessment of older adults with cancer.

Caring for older adults is not about prolonging life at all costs – and it is not an insurmountable challenge. Neither does it necessarily involve investing significantly in additional resources or diverting resources from other priorities.

It is, ultimately, about ensuring that the clinical expertise exists to identify the specific needs of older adults and offering them the same opportunities for diagnosis and treatment as other populations enjoy, in line with their wishes and particular situation.

Sonali Johnson is Head of Knowledge and Advocacy at the Union for International Cancer Control (UICC), which is hosting the World Cancer Congress in Geneva, 18-20 October.