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Planning for 2020: Increasing elderly
population poses huge challenges in Cancer
care
Huge challenges face healthcare
professionals and policy makers in planning
for, and providing cancer care over the next
decade or so.
Chief amongst these will be ensuring that
healthcare professionals have the skills and
knowledge to treat a greater number of
elderly people with cancer, that current
inappropriate ageist attitudes towards the
elderly cease, and that advances are made in
ensuring that cancer patients are able to
comply with their treatment.
In her keynote lecture to the European
Cancer Conference (ECCO 14) in Barcelona on
Monday, Kathy Redmond, who is editor of the
magazine Cancer World and also a nurse, will
say that these are "huge issues" that need
to be addressed now.
"It is almost impossible to predict what the
reality will be in 2020," she will say. "But
one thing is certain: there will be many
more elderly people living with cancer.
There is still far too much complacency
about this time bomb."
She will say that one problem is that as
people get older they may develop a number
of different conditions, only one of which
might be cancer. However, there are not
enough healthcare professionals who have
skills and knowledge in both cancer and the
best care and treatment of the elderly.
This is important because an elderly person
could be receiving treatment for several
different conditions and it is necessary to
know what impact those treatments are likely
to have on the elderly and also how they
might interact.
"I hope that ageism will be less prevalent
by then," Ms Redmond will say. "At present
there is a problem with persistent negative
attitudes to the elderly. Such attitudes
mean that many elderly cancer patients
receive sub-optimal cancer care. In fact,
there is an inverse relationship between
increasing age and the likelihood of proper
treatment despite evidence that otherwise
healthy elderly cancer patients can benefit
from treatment to the same degree as their
younger counterparts. Under-treatment and
sub-optimal practices mean that older
patients are dying unnecessarily from
cancer."
Non-adherence to oral, long-term cancer
therapies is emerging as a significant
problem in oncology and is set to increase
over the next decade because of the
increasing availability of oral targeted
therapies.
Ms Redmond will say: "There's an enormous
lack of awareness about the scope of
non-compliance in cancer and the fact that
this problem will become more prevalent in
the coming years. Patients do not comply
with treatment for many different reasons --
key factors are poor patient education and
ineffective side effect management. There is
a need to train health professionals how
best to promote treatment adherence and to
recognise when patients are not complying
with their treatment. Otherwise, cancer
outcomes will be compromised.
"The elderly are at higher risk of treatment
non-compliance because they are less likely
to receive comprehensive information about
their treatment, are more likely to have
literacy and memory problems, and often lack
the social networks that can help promote
adherence to treatment."
Cancer professionals can learn a lot from
specialties that have already had to deal
with treatment non-compliance in an
increasing elderly patient population. An
important first step is for cancer
professionals to recognise that a problem
exists so they can identify successful
strategies and adopt them into everyday
clinical practice.
Improved technology may come to the rescue
for some of these issues.
"Over the next two decades innovations in
technology, techniques and targeted
medicines will revolutionize approaches to
cancer care. These advances will enable more
cancers to be eradicated and others to be
controlled," Ms Redmond will say.
Remote monitoring of patients via their
mobile phones may become standard, robotics
may provide solutions to care in the home
and there may be other developments that we
can't even imagine at present.
"Advances in communication and information
technologies (ICT) will help address
communication and information gaps for those
who are ICT literate, however, a digital
divide will persist. There will be much
greater awareness of the importance of
cancer being managed by a multi-disciplinary
team composed of competent professionals
working in a centre of excellence. ICT
advances will help bring specialist care
closer to the patient's home. Where this is
not possible, informed patients will seek
out specialist care and be willing to travel
across European borders to access this care.
"Demographic changes will mean that greater
numbers of cancer patients will live alone
without social support. As the prevalence of
cancer increases, the cost of delivering
cancer care will escalate rapidly and may
grow beyond what most socialized health care
systems can bear. Expenditure on cancer
services will have to be strictly rationed
according to agreed priorities.
"What are the implications of these
developments for cancer patients" Most
cancer patients in 2020 will be elderly --
some very healthy, others extremely frail.
It is likely that there will be greater
disparities between those that have and
those that have not -- equity in access to
cancer treatment will be difficult to
guarantee. Well educated, internet savvy
elderly cancer patients with good social
support will be much more capable of
demanding access to optimal care. Policy
makers need to plan and invest today to
ensure that there will be an adequate
infrastructure in place to care for the
vastly increased numbers of cancer patients
in 2020. Patients should have a voice in
policy discussions to make sure that future
cancer services address disparities and
guarantee a minimum quality of care for
all," Ms Redmond will conclude.
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