A scoping review of ageism towards older adults in cancer care

Enhancing end-of-life care quality and achieving a good death for the elderly in Japan

BACKGROUND

In the context of an aging populations, there is an escalating need for palliative care tailored to the needs of the elderly. This study aimed to assess differences in symptoms and good death among the elderly, along with the structures and processes involved in end-of life care, and to explore the impact of age on achieving a good death.

METHODS

We conducted a questionnaire survey for bereaved family members of patients with cancer, heart disease, stroke, pneumonia, and kidney failure in 2019 and 2020. The study population was categorized into the following age groups: ≤64, 65-74, 75-84, and ≥85. The outcomes included symptom intensity, achievement of a good death, and receipt of quality care.

RESULTS

In total, 62,576 bereaved family members agreed to participate in the survey (response rate; 54.0 %). The weighted percentages of 'severe' and 'very severe' symptoms decreased with age. These trends were observed across age groups, even among the elderly. The strongest effect of age on achieving a good death was found for 'feeling that life is complete' with reference to those aged ≤64 years: 65-74 years (odds ratio [OR]; 2.09, 95 % CI; 1.94 to 2.25), 75-84 years (OR; 4.86, 95 % CI; 4.52 to 5.22) and ≥85 years (OR; 12.8, 95 % CI; 11.9 to 13.8).

CONCLUSION

Age-specific differences were observed in quality of death, quality of care, and symptom intensity. It is important to provide individualized consideration for each age group rather than categorizing them broadly as the elderly when caring for them.

An Age-Stratified Analysis of Early Postoperative Mortality Among Medicare-Eligible Patients With Common Gastrointestinal and Hepato-pancreato-biliary Malignancies

Background: The frequency of major cancer surgery in the elderly (≥80 years) has increased concomitantly with the rise in average age of the population. We assessed early postoperative mortality following hepato-pancreato-biliary (HPB) and gastrointestinal (GI) procedures for common malignancies stratified by age. Methods: The National Cancer Database (2004-2017) was queried for patients who underwent resection for GI (gastroesophageal and colorectal) or HPB (pancreatic adenocarcinoma, biliary tract, and primary liver) cancers. We compared early postoperative mortality (30 d and 90 d) stratified by age (65-79 vs ≥80 years) and procedure, and compared survival outcomes by age and operative vs nonoperative management. Results: A total of 709,358 patients were included. The 30-day mortality ranged from 1.8% to 5.8% among patients 65-79 years and from 3.2% to 12.4% among patients ≥80 years depending on procedure. The 90-day mortality ranged from 3.6% to 10.6% in patients 65-79 years compared to 8.4%-21.0% among patients ≥80 years. The overall 90-day mortality was 5.2% for patients 65-79 years and 12.0% for patients ≥80 years (P < .001). Age ≥80 was associated with worse survival among operatively managed patients with each upper GI, HPB, and lower GI malignancy relative to younger patients on multivariable analysis. However, operative management of patients ≥80 years was associated with improved survival relative to nonoperative management. Discussion: Elderly patients suffer higher postoperative mortality after major GI and HPB cancer surgery, but operative management is associated with improved survival among patients ≥80 years as compared to nonoperative management. These data are important to contextualize when counseling elderly patients on their treatment options for localized GI and HPB cancers.

Reclaiming Self-Balancing on a Tightrope Across Time a grounded theory of transition to survivorship in older adult blood cancer survivors

AIM

To develop a theoretical understanding of the transition to survivorship in older adult blood cancer survivors.

DESIGN

Qualitative research employing Classic Glaserian Grounded Theory methods.

METHODS

Purposive and theoretical sampling recruited 17 participants via Leukaemia & Lymphoma Society© Community webpages (65-83 years) from across the US and Canada. Data from individual semi-structured interviews using HIPPA-compliant Zoom© were analysed from September 2020 to March 2021.

RESULTS

Participants' main concern was losing their sense of self and reclaiming self was the core category. The substantive theory of Reclaiming Self-Balancing on a Tightrope Across Time is a six-phase transition process to survivorship: receiving a blood cancer diagnosis, finding bearings, reclaiming self, persevering through, realizing a transition and living in a new reality.

CONCLUSIONS

The transition to survivorship in older adult blood cancer survivors is a complex process because of age and disease type.

IMPLICATIONS

Age-related aspects of one's sense of self and its relation to health, well-being and quality of life, as older adult blood cancer survivors advance into older age need further research. Ageism and its impact on cancer survivorship care in older adults should also be explored.

IMPACT

What problem did the study address?: Existing theoretical frameworks do not explain the complex process of transition to survivorship for older adult blood cancer survivors. What were the main findings?: A substantive theory Reclaiming Self-Balancing on a Tightrope Across Time is a six-phase transition process from cancer diagnosis to survivorship characterized by an uncertain and liminal nature. Where and on whom will the research have an impact?: Understanding how older adults experience the transition to survivorship can inform age-appropriate person-centered nursing practices and healthcare policies specific to their needs.

REPORTING METHOD

COREQ.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Breaking the links between ageism and health: An integrated perspective

Ageism refers to prejudice, stereotypes or discrimination based on a person's actual or perceived chronological age. While ageism can affect people at all stages of the human lifespan, ageism against older adults has emerged as the most pervasive and potentially harmful. Much is now understood about how ageism can impact older people's health and wellbeing via structural, organisational, and provider level biases that threaten the provision of equitable and ethical healthcare. Negative attitudes about age and ageing also contribute to workforce shortages in aged care sectors, such as residential aged care and nursing. However, often underappreciated is how self-directed ageism, which refers to ageism turned against oneself, can also be an important determinant of health and wellbeing. Relative to external sources of ageism, negative internalised ageist beliefs are not only experienced more frequently in older adults' everyday lives, but are also more strongly linked to their health and wellbeing. Here we highlight how this understanding means that eliminating ageism requires a multifaceted approach that targets not only health care systems and aged care professionals, but older people themselves. Because normal age-related cognitive changes in how we think, perceive and reason increase the risk of older people viewing themselves through a negative and ageist lens, we provide a novel discussion of how broader insights from cognitive ageing literature must play a central role in any agenda focused on breaking the links between ageism and health.

Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol

BACKGROUND

The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults?

METHODS

We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review.

ETHICS AND DISSEMINATION

All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.

Survey of community and hospital pharmacist involvement in outpatient chemotherapy using Japanese health information data

In this study, information on injectable anticancer drug use and additional fee for enhanced collaboration (AEC) and additional fee for specific drug management guidance 2 (ASD2) claims from the NDB Open Data Japan (NODJ) dataset and the number of patients with cancer according to sex and age from the National Cancer Registry (NCR) dataset were integrated and evaluated to determine the current status and challenges in pharmacist interventions for patients receiving cancer treatment. The NODJ data, including receipt data billed from 2020 to 2021, were obtained from the Ministry of Health, Labour and Welfare website. The use of injectable anticancer drugs decreased relative to the number of cancer patients aged ≥ 75 years compared to those aged < 75 years. Regarding injectable anticancer drug use, the number of AEC claims was similar between men and women, but the number of ASD2 claims was lower in men than in women. The number of times community pharmacists claimed their ASD2 was approximately 5% of the number of times hospital pharmacists claimed their AEC. This study revealed that several patients did not receive sufficient guidance from community pharmacists compared to hospital pharmacists, suggesting a potential insufficiency in the collaboration between the two groups.

Supportive care and healthcare service utilisation in older adults with a new cancer diagnosis: a population-based review

OBJECTIVES

Older adults have unique needs and may benefit from additional supportive services through their cancer journey. It can be challenging for older adults to navigate the siloed systems within cancer centres and the community. We aimed to document the use of supportive care services in older adults with a new cancer diagnosis in a public healthcare system.

METHODS

We used population-based databases in British Columbia to document referrals to supportive care services. Patients aged 70 years and above with a new diagnosis of solid tumour in the year 2015 were included. Supportive care services captured were social work, psychiatry, palliative care, nutrition and home care. Chart review was used to assess visits to the emergency room and extra calls to the cancer centre help line.

RESULTS

2014 patients were included with a median age of 77, 30% had advanced cancer. 459 (22.8%) of patients accessed one or more services through the cancer centre. The most common service used was patient and family counselling (13%). 309 (15.3%) of patients used community home care services. Patients aged 80 years and above were less likely to access supportive care resources (OR 0.57) compared with those 70-79 years. Patients with advanced cancer, those treated at smaller cancer centres, and patients with colorectal, gynaecological and lung cancer were more likely to have received a supportive care referral.

CONCLUSIONS

Older adults, particularly those above 80 years, have low rates of supportive care service utilisation. Barriers to access must be explored, in addition to novel ways of holistic care delivery.

Enhancing collaboration between geriatricians, oncologists, and pharmacists to optimize medication therapy in older adults with cancer: A position paper from SOFOG-SFPO

Optimizing anticancer treatment and medication therapy in older patients with cancer requires a multidisciplinary approach, with a strong collaboration between geriatricians, oncologists and pharmacists. While all patients can benefit, some clinical situations seem to be high-priority. Careful attention should be given to patients with cardiovascular comorbidities and/or diabetes, which are prone to decompensate during anticancer treatment and often involve multiple medications. Another great concern is the risk of falls, closely related to polypharmacy, hence the need for a comprehensive medication review. Managing the pharmacological treatment of depression is also challenging and require shared expertise. Finally, pharmacists can prove valuable in situations of adherence difficulties or use of complementary medicines. Collaborative practice should begin at initiation of anticancer treatment and continue throughout the care pathway, as continuous reassessment is essential. Although the integration of pharmacists in multidisciplinary teams is often challenged by funding, collaborative should still be strongly encouraged.