‘Silver tsunami’ of older cancer patients to hit NHS

The rising ageing population will see UK cancer cases surge by a third within the next two decades.

Deaths are expected to rise by a quarter with six in 10 of those diagnoses in people over the age of 70 — up a fifth on current levels.

A meeting of 40,000 cancer experts this weekend warned health systems are woefully underprepared for the trend, which is mirrored globally.

They urged ministers to act now to tackle the shortage of cancer specialists coming down the line or said needless lives will be lost to the disease.

The situation is further complicated by older patients typically have multiple health issues and require more complex care, they said.

Latest NHS data on cancer waiting times showed the 62-day cancer backlog has fallen for the first time since before the pandemic. But almost 6,000 patients did not start treatment within two months of an urgent referral from their GP. It means only 63 per cent of cancer patients in total were seen within the two month target. NHS guidelines state 85 per cent of cancer patients should be seen within this timeframe but this figure has not been met since December 2015

Dr Andrew Chapman, a leading geriatric cancer specialist from Thomas Jefferson University Hospital, Philadelphia, said without urgent action, older patients ‘are going to get suboptimal care.’ He said treatment of pensioners was often ‘nihilistic’ and told health leaders to ensure that ‘ageism is not acceptable’.

Speaking at the American Society of Clinical Oncology in Chicago, he said: ‘The point behind the silver oncologic tsunami is that as the population expands and the incidence goes way up, are we really prepared to deal with those needs? I think globally, we’re not.’ He added: ‘Sometimes there’s a nihilism – “if you’re older we’re not going to bother” — which is horrible.

‘Age is not that relevant. The point is how physically fit you are and not everybody the same age is the same level of fitness. So that’s not fair…’ 

He said health services needed to train more people to cope with the demands of older patients, which are typically very different to the young.

Treatment should be based around the wants of the individual patients rather than adopting a universal approach.

‘It needs to be a shared discussion to say, “These are really what my goals are, this is what I’m trying to achieve”,’ he said.

‘Most of the time, older adults care more about maintaining their function than they necessarily care about the cancer. They want to go to weddings, they want to see their grandkids, they want to play golf.

‘If you’re going to give somebody treatment that’s going to take that away, they may not want it. 

‘It’s much different than somebody who’s 45 who wants to live for another 40 years. It’s a different game.’

Speaking alongside him, Dr Tina Hsu of The Ottawa Hospital in Ottawa, Ontario, Canada, said ‘the time is right’ to develop geriatric cancer services.

She said multiple trials had shown ‘a tangible benefit to our patients’ from considering measures such as frailty before beginning treatment.

She said: ‘I think that there is an urgency to implement their knowledge into care for our patients that our patients can benefit from what we know.

‘We already are in the moment where we are seeing more and more older adults with cancer. It’s not something that [is] going to happen in the future.. I think it’s happening now. And so there is an urgency.’ 

Cancer Research UK estimates cases will hit half a million annually for the first time by 2040.

In total, there could be 8.4million new cases of cancer and 3.5million cancer deaths in the UK between now and then.

Professor Charles Swanton, chief clinician for Cancer Research UK, echoed the concerns over the UKs preparedness.

Older cancer patients often have comorbidities and other diseases like cardiovascular disease, heart or respiratory problems, he said, which can impact on treatment.

‘These patients are on multiple drugs and their ability to tolerate chemo is less good, they are often weaker. So they require much more assiduous medical management.

‘The question is, how is the health system going to cope with that?

‘We have a workforce problem now with around 384,000 cancer cases a year today, which is projected to rise to over half a million in 2040.

‘We have already got a major challenge with workforce in the NHS, and that is combined with an increasing exodus of doctors from the health service either moving to other jobs or leaving the country.’ 

While survival rates have improved, the UK continues to lag behind much of Europe with record waiting times doing little to reverse that trend.

Strikes by nurses, junior doctors and ambulance workers have added to the disruption caused by Covid and flu seasons, resulting in more than 500,000 appointments and operations being postponed.

A report by the Royal College of Radiologists found a 17 per cent shortfall of clinical oncologists in 2021, meaning the UK was short of 189 trained specialists.

It also suggested widespread regional disparities for older patients with those in London having access to three times as many cancer specialists as people in parts of Wales and the East Midlands, at 9.6, 3 and 4.5 per 100,000 population respectively.

Dr Julie Gralow, ASCOs chief medical officer, said: ‘Shortages in the cancer care workforce are a concern globally, and those workforce concerns become particularly pressing when you consider the growing number of older adults and the fact that cancer risk increases with age.

‘The current gaps in the global oncology workforce must be addressed.’ Last night, charities echoed calls for more specialist doctors to treat older patients.

Caroline Abrahams, Charity Director at Age UK, said: ‘To manage the increased demand this represents the NHS will need more clinicians, especially more Geriatricians — consultants who understand older people’s health in the round.

‘This skill set is particularly important because we know that many older people with cancer are managing other long term health conditions as well, and they need treatment and support that takes into account how these various problems interact in our ageing bodies.’

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