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Gomes F, Lewis A, Morris R, Parks R, Kalsi T, Babic-Illamn G, Baxter M, Colquhoun K, Rodgers L, Smith E, Greystoke A, Bayman N, Cree A, Ng C, de Liguori Carino N, Basile S, Moore J, Merchant Z, Swinson D, Parbhoo A, Jones R, Davies E, Danson SJ, Young R, Morgan J, Wyld L, Corrie PG, Doherty GJ, Crawford K, Wright J, Reed M, Ugolini F, Lind M, Cheung KL, Harari D, Simcock R. The care of older cancer patients in the United Kingdom. Ecancermedicalscience 2020; 14:1101. [PMID: 33082851 PMCID: PMC7532033 DOI: 10.3332/ecancer.2020.1101] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.
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Affiliation(s)
- Fabio Gomes
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Anna Lewis
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Rob Morris
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Ruth Parks
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Tania Kalsi
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RS, UK.,King's College London, London SE5 9RS, UK
| | | | - Mark Baxter
- Ninewells Hospital, NHS Tayside, Dundee DD2 1SG, UK
| | - Kirsty Colquhoun
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Lisa Rodgers
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Eleanor Smith
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Alastair Greystoke
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Neil Bayman
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Anthea Cree
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Cassandra Ng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | | | - Simone Basile
- Royal Manchester Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - John Moore
- Royal Manchester Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Zoe Merchant
- Greater Manchester Cancer, Manchester M20 4BX, UK
| | | | - Anita Parbhoo
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Rachel Jones
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Eleri Davies
- University Hospital of Llandough, Cardiff and Vale University Health Board, Cardiff CF64 2XX, UK
| | - Sarah J Danson
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Robin Young
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Pippa G Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Gary J Doherty
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Kyle Crawford
- Belfast Health and Social Care Trust, Belfast BT13 1FD, UK
| | - Juliet Wright
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK
| | - Fiammetta Ugolini
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Sussex BN2 5BD, UK
| | - Michael Lind
- Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.,Co-senior authorship
| | - Danielle Harari
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RS, UK.,King's College London, London SE5 9RS, UK.,Co-senior authorship
| | - Richard Simcock
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Sussex BN2 5BD, UK.,Co-senior authorship
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DeSantis CE, Miller KD, Dale W, Mohile SG, Cohen HJ, Leach CR, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin 2019; 69:452-467. [PMID: 31390062 DOI: 10.3322/caac.21577] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adults aged 85 years and older, the "oldest old," are the fastest-growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.
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Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - William Dale
- Department of Supportive Care Medicine, Center for Cancer and Aging, City of Hope National Medical Center, Duarte, California
| | - Supriya G Mohile
- Wilmot Cancer Center, Geriatric Oncology Research Program, University of Rochester Medical Center, Rochester, New York
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Corinne R Leach
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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