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Cancer Research UK Cambridge Institute

 
Elderly cancer patient

In the second part of our series on old age and cancer, we look at how the NHS needs to adapt as the number of cancer cases diagnosed in older people is projected to rise.

Every year around 130,000 people aged 75 and over in the UK are told they have cancer. By 2035 this is projected to rise to around 234,000.

This means that in just under 20 years, almost half (46%) of people diagnosed with cancer each year in the UK will be over 75.

Cancer is primarily a disease of ageing. And as we age, we’re more likely to develop other health conditions too. This means older cancer patients often need extra support to get through treatment or to recover from it.

This added complexity of cancer care, alongside growing numbers of patients, points to a future where the NHS will need to adapt to provide this additional support and the best care possible.

The problem is the NHS is already under a lot of pressure, including facing severe staff shortages. And there’s the added challenge that older patients already tend to have poorer outcomes than their younger counterparts. If the UK is to give all cancer patients the best chance of survival, the NHS must focus on improving outcomes for older patients.

Our new report published today summarises the challenges facing the NHS as our population ages. It’s based on interviews and surveys with patients, health professionals and people who make decisions about NHS care. And the conclusions highlight how services must act to make sure they’re working well for older people with cancer now, and in the future.

What’s the problem?

Evidence shows that right now, UK cancer services aren’t doing as well as they should for older people with cancer.

Cancer survival is generally lower for older patients, even when taking into account other health conditions that older people may also have. The cancer survival gap between the UK and other similar countries is also worse for older patients than it is for younger patients.

And despite survival doubling over the past 40 years, the gap in survival between younger and older patients remains.

One explanation for this is that older patients are less likely to have several different types of treatment that could help them live longer.

Why are older patients not having as much treatment?

In some cases, patients might choose not to have intensive treatment, either because they’re not well enough or because they’re prioritising their independence and quality of life, rather than trying to extend their lives at any cost. That decision is up to each patient and their loved ones. But it raises the challenge of how to have complex conversations when consultation times and NHS staff are stretched.

But sometimes, the treatment people are offered isn’t based on a full assessment of how fit they are, how much support they need, or how well they will be able to cope with treatment. This means that sometimes older patients aren’t given the best possible treatment for them.

In contrast, from speaking to older people with cancer in our research, we heard that some feel under pressure by their doctors to have intense treatment, and don’t feel like their doctors give them enough information about the side effects they could face.

Mostly, it was assumed that I would do whatever they suggested […] I do not feel in hindsight that I was given much choice, or indeed support to make that choice

– Patient

The NHS needs to get the balance right. No two patients are the same, so cancer treatment and care plans should be shaped around each person’s individual situation – including their social and medical needs.

What’s the solution?

It can be difficult to make a busy health service a personalised one. And when staff are under so much pressure, it’s hard to find enough time for in-depth conversations about options. But it’s vital the NHS finds a way.

Today I had a patient who has cancer but has other comorbidities […] so I had to discuss that […] and make it clear to them that these are the risk factors, these are the things that go wrong […] that 20/30 minutes […] gets dragged on to 45 minutes. We can’t just stop the consultation because it’s been running out of time

– Anaesthetist

But there are ways that this process can be made easier. And we think it hinges on finding better ways of assessing older patients’ needs.

This was highlighted in the 2015 Cancer Strategy for England, which said that methods of assessing older patients weren’t fit for purpose, “resulting in older people’s needs not being identified or understood”.

In our research, we found that although doctors know that gauging frailty is important, very few places use the most comprehensive tests and assessments. We’d like to see this change.

These assessments help doctors predict how well a patient will cope with treatment, and the support they might need. They should be used consistently for everyone. That’s why we want health services to roll these out across UK cancer services. And we’ll be exploring how research might help improve assessments in the next post in this series.

The NHS must also make sure patients receive the support they and their loved ones need to get through treatment and recover from it.

It’s one thing to choose to decline treatment, because the effort of chemotherapy and how ill it’s going to make you feel isn’t worth (it) […] It’s very different to making a decision based on ‘I can’t get the care for my husband or I can’t get the care for my wife or I don’t have transport to get to the chemotherapy […] or I’ll feel too rubbish afterwards and there’s nobody around to do my cooking and cleaning’

– National interviewee

There are also ways to help make sure cancer teams have enough time to discuss complicated cases in depth, by making the multidisciplinary team meetings (MDTs) more efficient and effective.

One of the issues for all MDTs is managing to comprehensively get through the cases in a meaningful way in which we [healthcare professionals] make the right selection of treatment strategies when you’ve maybe got […] forty patients plus at an MDT

– Clinical oncologist

Fundamental to all of this is information, which needs to be shared more effectively. This means sharing information between GPs, doctors and cancer teams. But perhaps most importantly, it means sharing information with patients, to help support discussions and decisions.

This isn’t easy, and there are lots of different groups involved. So, to make all of this happen, and to do it well, the NHS needs more staff.

For 70 years, the NHS has been at the forefront of fighting cancer. But it needs more investment in staff. And while it’s great that there’s now extra funding, this falls short of what’s needed to transform how patients of all ages are cared for.

If the Government is serious about its bold ambitions for improving cancer survival and care, this needs to change. And older patients need to be a part of it.

Rose Gray is a policy manager at Cancer Research UK

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21 Jun 2018

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