Ensuring that older adults are not forgotten about in Government Cancer Strategies

Kirsty Colquhoun is a Consultant Geriatrician in NHS Greater Glasgow and Clyde.  As part of this role she delivers an oncogeriatric service within COPS, the Cancer Older People’s Service in The Beatson, West of Scotland Cancer Centre, also working with Maggie’s and MacMillan Cancer Support.  She is the Secretary of the BGS Oncogeriatrics SIG. She tweets @colki1983

Oncogeriatrics, or geriatric oncology, is not niche. 1 in 2 of us will face cancer in our lifetime. The number of older adults living with cancer is set to triple between 2010 and 2040, and 60% of cancer diagnoses are made in the older population. We know that the ageing population will add complexity to cancer management; and will require services to juggle issues that teams managing older adults are already expert in managing  — issues like comorbidity, frailty, polypharmacy, and functional decline. 

I was pleased to see this issue recognised by the Scottish government in their newly published independent analysis of the public consultation for their cancer strategy over the next ten years.  With the cancer strategy due to be published in Spring. As part of the consultation, the BGS submitted its response alongside 101 other organisations and many individuals.  Had it not been for this response, very little mention would have been made of older, frailer, patients with cancer, despite the fact they make up the majority group of people with the disease.

I was also pleased to see specific points mentioned by the BGS highlighted in the analysis, including the need for:

• Timely access to rehabilitation in a place most suitable to the individual;
• Access to suitable “prehabilitation”– aiming to prevent the poorer outcomes we see in the 27% of older cancer patients that have sarcopenia;
• The recognition that emergency and late diagnosis is more common in the older patient;
• The health inequalities that older adults face – such as poorer survival outcomes compared to other countries;
• The recognition that the cancer workforce needs to be educated in looking after older adults – acknowledging that currently the majority of oncologists do not receive specific training in looking after older adults;
• Greater representation of older adults in clinical cancer trials — currently we know this group is under-represented.

The BGS highlighted many more issues as part of the consultation, which will need to be considered in the final 10 year cancer strategy, including:

• The need for access to CGA and the workforce planning that goes alongside that;
• The urgent need to tackle our social care crisis;
• The need to make cancer care suitable for those with cognitive impairment.  Delirium is common in the cancer setting, and 1 in 13 older adults with cancer will also have dementia;
• The need for recognition that older adults often present atypically with cancer, and therefore do not fit into traditional diagnostic pathways. Pathways must exist to ensure that these patients don’t miss out on a timely diagnosis. 

The BGS has also submitted a response to the consultation on the development of a 10-year cancer plan from the Department of Health and Social Care in England. However, this strategy has now been superseded by the Major Conditions Strategy, announced by the Secretary of State earlier this year. Little detail is known about the Major Conditions Strategy as yet, although we know that cancer is included as one of the major conditions (although frailty is not). It is important that we continue to engage with governments and policy leaders in order to ensure our voice is listened to and the older, frailer adult is represented in the final cancer strategies.