In this week's Birmingham Brief, a research team from the Health Services Management Centre reflect on their work to understand the specific needs of older people living with cancer and identify the challenges facing the NHS as our population ages.
In 2005, 8,000 people aged 75 and over were diagnosed with a cancerous tumour in the West Midlands. By 2016, this number had risen to over 11,000 – a rate increase of 38 per cent. This local trend reflects the bigger picture in the UK.
In 2015, around 360,000 people were diagnosed with cancer in the UK; of these people, 36 per cent were 75 and over. In the next 20 years, the proportion is set to rise to almost half – 46 per cent of all cancer cases will be diagnosed in those aged 75 and over.
Research conducted by the University of Birmingham’s Health Services Management Centre – Advancing care, advancing years: improving cancer treatment and care for an ageing population – was launched by Cancer Research UK last month. The work aimed to understand the specific needs of older people living with cancer and identify the challenges facing the NHS as our population ages. Conclusions highlight areas where cancer services can act to ensure that they are working well for older people, now and in the future.
Defining an ‘older person’ in a way that is relevant to the cancer care that they should receive is much more complex than just taking their age into account. Working with national organisations, patients, carers, acute and primary care staff, our research team distinguished the characteristics that are associated with problematic experiences of treatment and care of older people. Identified problems included multiple health conditions, cognitive issues and complex social care needs – but not everyone over the age of 75 displayed these characteristics, and not all those under 75 were unaffected by them.
Above all, people with these needs are worthy of policy focus because they are the most likely to suffer negative impacts caused by the pressures that the NHS and social care are facing. These pressures place limitations on practitioners’ time and the availability of specialist staff (such as cancer specialist nurses and geriatricians). These pressures can also restrict access to transport during treatment and to the social support services that are often vital for the rehabilitation and ongoing care of frail older people.
Cancer care should adapt to accommodate the complexity of cancer cases in our ageing population. A system that serves older people best will see improvements in: generating better data about treatment outcomes for older people with multiple conditions; considering additional information (especially about frailty) in clinical treatment recommendations, and providing the space and skills to share complicated decisions with patients and their families.
For a growing number of older people, cognitive impairment limits capacity to understand and choose treatment. This often calls for a prolonged decision-making period where treatment options need to be ‘shared’ with the wider family or support services, who may not always be in agreement with each other. Finding the time to work with this complexity does not always fit easily into the timeframes of a closely monitored cancer service and, in the worst cases, ends with treatment decisions being reversed.
The 2015 Cancer Strategy observed that cancer pathways are flawed by inadequate assessments of older people’s needs. Investigating these claims, we saw that clinical decision-making does not always take every relevant factor into account; detailed assessments of frailty and personal circumstances are not regularly undertaken. Information that could be important to treatment should flow better between GP practices and hospital care teams. To enable the inclusion of older people, we must ensure that treatment innovations are reaching them. Cancer teams told us that a lack of clinical evidence about how newer treatments work for older people acted as a barrier to treatment.
These findings, and their recommendations, offer solutions to the challenges that a demographic change brings for healthcare systems.
