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Planning for 2020: increasing elderly population poses huge challenges in cancer care

Huge challenges face healthcare professionals and policy makers in planning for, and providing cancer care over the next decade or so.

Chief amongst these will be ensuring that healthcare professionals have the skills and knowledge to treat a greater number of elderly people with cancer, that current inappropriate ageist attitudes towards the elderly cease, and that advances are made in ensuring that cancer patients are able to comply with their treatment.

In her keynote lecture to the European Cancer Conference (ECCO 14) in Barcelona on Monday, Kathy Redmond, who is editor of the magazine Cancer World and also a nurse, will say that these are “huge issues” that need to be addressed now.

“It is almost impossible to predict what the reality will be in 2020,” she will say. “But one thing is certain: there will be many more elderly people living with cancer. There is still far too much complacency about this time bomb.”

She will say that one problem is that as people get older they may develop a number of different conditions, only one of which might be cancer. However, there are not enough healthcare professionals who have skills and knowledge in both cancer and the best care and treatment of the elderly. This is important because an elderly person could be receiving treatment for several different conditions and it is necessary to know what impact those treatments are likely to have on the elderly and also how they might interact.

“I hope that ageism will be less prevalent by then,” Ms Redmond will say. “At present there is a problem with persistent negative attitudes to the elderly. Such attitudes mean that many elderly cancer patients receive sub-optimal cancer care. In fact, there is an inverse relationship between increasing age and the likelihood of proper treatment despite evidence that otherwise healthy elderly cancer patients can benefit from treatment to the same degree as their younger counterparts. Under-treatment and sub-optimal practices mean that older patients are dying unnecessarily from cancer.”

Non-adherence to oral, long-term cancer therapies is emerging as a significant problem in oncology and is set to increase over the next decade because of the increasing availability of oral targeted therapies. Ms Redmond will say: “There’s an enormous lack of awareness about the scope of non-compliance in cancer and the fact that this problem will become more prevalent in the coming years. Patients do not comply with treatment for many different reasons – key factors are poor patient education and ineffective side effect management. There is a need to train health professionals how best to promote treatment adherence and to recognise when patients are not complying with their treatment. Otherwise, cancer outcomes will be compromised.

“The elderly are at higher risk of treatment non-compliance because they are less likely to receive comprehensive information about their treatment, are more likely to have literacy and memory problems, and often lack the social networks that can help promote adherence to treatment.” Cancer professionals can learn a lot from specialties that have already had to deal with treatment non-compliance in an increasing elderly patient population. An important first step is for cancer professionals to recognise that a problem exists so they can identify successful strategies and adopt them into everyday clinical practice.

Improved technology may come to the rescue for some of these issues. “Over the next two decades innovations in technology, techniques and targeted medicines will revolutionise approaches to cancer care. These advances will enable more cancers to be eradicated and others to be controlled,” Ms Redmond will say. Remote monitoring of patients via their mobile phones may become standard, robotics may provide solutions to care in the home and there may be other developments that we can’t even imagine at present.

“Advances in communication and information technologies (ICT) will help address communication and information gaps for those who are ICT literate, however, a digital divide will persist. There will be much greater awareness of the importance of cancer being managed by a multi-disciplinary team composed of competent professionals working in a centre of excellence. ICT advances will help bring specialist care closer to the patient’s home. Where this is not possible, informed patients will seek out specialist care and be willing to travel across European borders to access this care.

“Demographic changes will mean that greater numbers of cancer patients will live alone without social support. As the prevalence of cancer increases, the cost of delivering cancer care will escalate rapidly and may grow beyond what most socialised health care systems can bear. Expenditure on cancer services will have to be strictly rationed according to agreed priorities.

“What are the implications of these developments for cancer patients? Most cancer patients in 2020 will be elderly – some very healthy, others extremely frail. It is likely that there will be greater disparities between those that have and those that have not – equity in access to cancer treatment will be difficult to guarantee. Well educated, internet savvy elderly cancer patients with good social support will be much more capable of demanding access to optimal care. Policy makers need to plan and invest today to ensure that there will be an adequate infrastructure in place to care for the vastly increased numbers of cancer patients in 2020. Patients should have a voice in policy discussions to make sure that future cancer services address disparities and guarantee a minimum quality of care for all,” Ms Redmond will conclude.

Mary Rice | alfa
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