Cancer Risk Is 11x Higher After 65. Why Is Geriatric Oncology an Afterthought?
Why Geriatric Oncology Promises the Next Huge Advance in Cancer Care
By Michael Hodin
Oncology is one of the great success stories of modern medicine. Since the early 1990s, the death rate from cancer has declined by nearly 30% in the U.S, thanks in large part to the innovations that have led to advances in treatment and care. In the EU, 5.4 million cancer deaths were avoided between 1989 and 2022, and, globally, the overall cancer mortality rate fell by about 10% from 2000 to 2010. Yet the oncology field, and health systems overall, are still struggling with the challenge hiding in plain sight: the daunting increase in cancer prevalence among older people, itself exponentially multiplied by the 1 billion of us now living past 60 particularly subject to cancer risk. This area — geriatric oncology — is a huge global need demanding the next huge advance in cancer treatment and care.
As laid out by the UN/WHO’s Decade of Healthy Ageing, mitigating the surge in age-related health challenges requires solutions specifically designed for the needs of older adults. Providers, health system leaders, policymakers, innovators and other stakeholders must take steps to ensure older people can access appropriate, integrated care, while combatting the widespread ageism that assumes care approaches are one-size-fits-all, too often based on the needs of younger people.
Oncology is a case in point. Even though people 65+ are 11 times more likely to develop cancer, most oncology specialists lack expertise with this group. In a survey of American cancer practitioners, only 17% carried out geriatric assessments of their patients. In the UK, just 27% of oncology trainees were confident assessing risk to make treatment recommendations for older patients — compared to over 80% for younger patients. And it’s no wonder: two-thirds of trainees never received training on the needs of older people, who face large and unique risks. These risks have only been exacerbated by the pandemic, as older cancer patients are one of the groups most vulnerable to COVID-19.
New research from Sanofi and KPMG highlights the scale of the challenge. In China, the U.S., the UK, and the EU4, cancer burden will increase by 80% among older adults over the next two decades. This also has immense socio-economic consequences. The total economic impact of cancer already equals 1 to 2% of GDP in China and Europe, which will grow to around 3% of GDP by 2040. In addition, there is a significant caregiver burden, amounting to $83 billion in Europe, $46 billion in the U.S., and $20 billion in China over just the two years measured in the study. In other words, the fiscal and economic burdens match the healthcare challenges themselves, coming together to cry out for older adults’ cancer needs to be addressed, urgently.
With this magnitude of impact, geriatric oncology should be a primary concern, not just for cancer specialists, but also health, finance, trade and economic ministers, and policymakers at every level of government. A range of strategies can help step-up responses:
· Improve monitoring and earlier diagnosis leading to better and more widespread usage of geriatric assessment tools for older cancer patients. We already have the tools — but we’re not using them. Geriatric assessments can identify health problems otherwise not detected during routine cancer care, improving survival rates, supporting quality of life, and reducing care costs. But few cancer practitioners are using them. Medical societies, health systems, and policymakers should integrate these assessments into oncology recommendations and decision-making to deliver a higher standard of care for older patients.
· Integrate geriatrics into oncology training and continuing education. Shouldn’t specialists receive training on the population they’re most likely to treat? Medical schools can better equip future oncologists by including geriatric oncology in their curriculum, while medical societies can provide CME modules on geriatrics. And governments can appoint a national lead or working group on geriatric oncology to coordinate training across the country and globally.
· Include more older adults in cancer research and clinical trials. Older patients are not adequately represented in oncology clinical trials, leading to gaps and blind spots about the best treatment approaches. Conducting clinical trials specifically on treatment strategies for older patients can help to correct these oversights and give providers the knowledge they need for evidence-based treatment decisions. This ageist approach to healthcare is, literally, deadly. And surely, we can learn from Covid-19 vaccine innovation, where early in the trials older adults were included far beyond traditional numbers because of widespread recognition of the particularly high risks to this age demographic. Let’s apply this lesson to cancer, starting today.
· Connect cancer care with the best technologies and models for elder care. The challenges of treating older cancer patients are closely linked to the challenges of elder care, overall. For example, cancer treatments can increase the risk of a potentially devastating fall. To address these risks, geriatric oncology can connect with remote care technologies and AI-enabled tools, home care, fragility fracture prevention/rehab programs, and other models that have emerged as best practices for elder care. There is also the benefit here of better and more effective integrated care — one of the four core areas of the Decade of Healthy Ageing, where the WHO ICOPE can play a critical role.
Focusing on the needs of older patients represents the next frontier for oncology, where advances in care can deliver vital benefits for patients, caregivers, and families, as well as our overall economies and societies. To start, we need to put the geriatric oncology tools and trainings that already exist into the hands of those who are already caring for the fast-growing population of older cancer patients.
