If you were to ask most people what causes cancer, the answer would probably be . But the most important risk factor for cancer is something else: . That’s right, the factor most associated with cancer is unavoidable — and a condition that we will all experience.
Why is this important? Older adults are the . By 2068, approximately . With cancer being one of the and one of the most common diseases in Canada, it means we need to think about how to provide the best cancer care for older adults.
Demographic shift
So how are we doing so far? The answer is: not great. This may be surprising, but we also have a great opportunity to innovate and prepare for this demographic shift in cancer care.
International guidelines — including those from the American Society of Clinical Oncology — say that all older adults prior to making a decision about their cancer treatment. The most widely used models of geriatric assessment .
Consultation with a geriatrician for an older adult allows the oncologist and older adult to engage in a conversation about cancer treatment armed with information. Things like how treatment might affect their cognition, their function, their existing illnesses (), and the years of remaining life.
Importantly, geriatricians centre their assessment on what matters most to patients. This approach anchors any decision about cancer around the wishes of older adults and their support system. When diagnosed with cancer, older adults undergo many tests and measures of function, but the evidence supports that these are for identifying problems that may be below the surface.
Care in Canada
In Canada, there are currently only a handful of specialized geriatric oncology clinics. The oldest clinic is in Montréal , followed closely by the , led by Shabbir Alibhai, one of the authors of this story. As researchers, we are in touch with clinics in Ontario and Alberta that have told us they have geriatric oncology services under development, so we hope to see new programs soon.
These clinics aren’t just good for patients. In fact, demonstrated a cost savings of approximately $7,000 per older adult seen in these clinics. If we map this onto the number of older adults diagnosed with cancer in Canada every year, this represents a huge cost savings for our public health system. Despite this overwhelming evidence, this is still not routine care.
In British Columbia, there are currently no specialized services for older adults with cancer. , Kristen Haase — also an author of this story — has been working with colleagues to understand whether these services are needed and how they could help older adults with cancer in 小蓝视频
This work involved conversations with more than 100 members of the cancer community. The research team spoke with older adults undergoing cancer treatment, who sometimes had to relocate for cancer treatment. Other participants included caregivers who cared for elderly family members during their cancer treatment and described numerous challenges they faced, and volunteers who ran a free transportation service — a service also mostly staffed by older adult volunteers.
The research team also heard from health-care professionals: oncologists, nurses, physiotherapists and social workers. The latter group coalesced around the need for additional supports within the cancer care system so they could do their job well, and best support older adults.
The results indicate that both those working in the system and those using the system want and need better support.
Barriers to care
So where are we now and why don’t we have these services across Canada?
Cost is obviously a barrier to any health-care service. But with evidence that any costs will be offset by demonstrated cost savings, this is a non-starter.
Health human resources are one huge restriction. Geriatricians are in high demand and there is . However, . With the expanding role of nurse practitioners across Canada, this option has huge potential .
Another reason is good old inertia. Our has remained mostly intact for over three decades. It is primarily a single . Although have emerged at a breathtaking pace and have been introduced into clinical practice, it is much harder to , particularly for strategies such as geriatric assessment that are than a new drug or surgical/radiation technique.
The last, and perhaps the most difficult to pin down of all potential reasons for the absence of specialized cancer services for older adults, is agism. Agism is discrimination based on age. It is one of the most common forms of discrimination and it is . Imagine a scenario where children diagnosed with cancer couldn’t access a pediatrician. We would collectively be outraged. Yet somehow, we accept this for older adults.
Due to the overwhelming number of older adults who are and will be diagnosed with cancer in the coming years, it will never be possible for all of them to receive specialized geriatric services. But there is an opportunity to innovate models of care that are targeted to those who need services the most: those who are most frail, are most likely to benefit from tailored care, and will reap the most benefit in terms of quality of life.
Stratifying these programs around those who need them the most will also have the greatest financial impact. And if personal stories of improving quality of life for older adults with cancer or international guidelines don’t move decision-makers, hopefully cost savings will.
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.