Advancing Cancer Care & Patient Choice in Super-Aging Japan
by Mike Hodin
As governments, policymakers, and health systems set their agendas for 2024 and beyond, they’d be wise to consider the lessons and models emerging from super-aging Japan — effectively, a window into the future for all aging countries around the world. Most of all, Japan shows how far-sighted policy can support the health, independence, and dignity of older people living with age-related health conditions like Cancer, Alzheimer’s, or the effects of Osteoporosis on Second Fracture Prevention and how doing so is as much an economic and societal imperative as a matter of health policy.
Advancing cancer care for older people is now coming to the fore, as around three-quarters of Japan’s one million cancer patients are older adults. This group has unique needs and challenges compared to younger cancer patients, but policies and care models have generally lagged behind the need. In response, Japan revised cancer guidelines in 2022 to help ensure these older patients are included in decision-making about their own care, aiming for older people to receive “appropriate care at the places that they wish to receive it.”
The rest of the world should pay attention, given the immense socioeconomic impacts of cancer on the global economy. According to a report from Sanofi and KPMG, When Cancer Grows Old: Assessing the Socio-economic Burden of Cancer and Ageing and the Policies Required, the total economic impact of cancer represents fully 1–2% of GDP in China, the EU4, the UK, and the US, further projected to reach ~3% by 2040. Yet cancer care for older adults has rarely been a healthcare priority, much less an economic one. And even the KPMG Report could do with an update that would specifically include Japan and more of a focus on Care for Older People and their Families living with Cancer.
Japan’s updated policy guidelines are an important step in this area — but at a recent Global Coalition on Aging roundtable, “How to Better Support Older Adults and Their Families for Shared Decision-Making About Cancer Care” experts agreed that more can still be done. Cancer care must be based on the decisions, priorities, and preferences of older patients. However, achieving this requires addressing an incredible degree of complexity: complex care options, for a complex disease, running along a complex patient journey, with a complex set of providers, specialists, caregivers, and facilities along the way.
How can health systems tame all that complexity to enable shared decision-making? Four broad action areas point a way forward to empower older patients as the decision-maker in their own care:
First, provide care teams with the tools to understand each patient’s needs and capacities. Older people are not a single, monolithic group; far from it. Effective care must account for a huge diversity of different needs, comorbidities, capacities, and available support systems. Here, geriatric assessments can help care teams to evaluate people’s decision-making capacity. Health systems must work to ensure much wider availability of these tools, provide medical education on how to use them, and set protocols for their uptake.
Second, create a designated role to help older adults and their families navigate care and communication. Oncology teams are often large, sometimes leaving patients unsure about their main point of contact. A designated “patient navigator” can help streamline communications and serve as a trusted voice for the patient throughout the entire journey. For the care team, the navigator can help to manage the integration of care workers, pharmacists, nurses, and others into decision-making, as well as the usage of digital tools.
Third, train more healthcare providers in geriatric oncology. This should include increasing the number of specialists in the field — who will be meeting a huge societal and healthcare need — as well as training providers from other fields on how to use tools for geriatric oncology. We know that older cancer patients have unique needs, and that the number of older patients will only grow as populations age; preparing providers for this reality should be a common-sense step for health systems worldwide.
Finally, across it all, strengthen healthcare and reimbursement systems to support freedom of choice. This links directly to the fight against ageism, which has too often foreclosed options for older patients under the deadly assumption that they are somehow worth less effort, or that cancer is just a “normal part of getting old.” Patients should enjoy broad access to cancer treatments regardless of their age, as the basic starting point for care decisions.
For decades, Japan has led the world with innovative solutions to adapt for population aging, understanding the many linkages between demographics, health, economics, and society. Action to advance better cancer care for older patients would continue that proud leadership, address a growing driver of socioeconomic costs, and, most importantly, empower each person to make decisions about their own life and health.
