Virtually every region and country in the world are experiencing an epidemiological transition characterised by increasing life expectancy and population ageing. Although developed regions of the world such as North America and Western Europe still have the largest proportion of older persons, the absolute number of older adults is higher in developing regions of the world such as Asia, India, and Latin America.
Currently, more than 60% of individuals aged 65 and older are living in low- and middle-income countries and, over the next decades, the number of older persons is expected to grow faster in regions such as Latin America (71% increase), Asia (66%) and Africa (64%). This increasing percentage of older adults will have a transforming impact on all sectors of society, including, of course, healthcare. Preparing for population ageing through the creation of strong and resilient systems that can provide care that includes geriatric principles is essential to ensure future progress and development.
Noncommunicable diseases, including cancer, are strongly associated with increasing age, and the number of new cancer cases is projected to increase in parallel with population ageing, particularly in developing regions of the world. To provide high quality care for the growing population of older adults with cancer, there is a need to increase the geriatric competency of the entire healthcare workforce. Various studies have shown that the inclusion of geriatric principles into oncological care can improve both geriatric outcomes, such as function and mood, and cancer-related outcomes such as quality of life and treatment toxicities.
Both the International Society of Geriatric Oncology (SIOG) and the American Society of Clinical Oncology (ASCO) recommend performing a geriatric assessment before starting treatment in older patients with cancer, and to use its results to implement interventions aimed at improving patient care and to tailor cancer treatment. ASCO recommends for geriatric assessments in oncology to include at least measures of functionality, mood, comorbidities, an assessment of medications, an evaluation of falls, and a cognitive screening.
In order to improve the care of older patients with cancer, we also need to develop global initiatives aimed at improving education, enhancing clinical practice, fostering research and developing collaborations and partnerships.
The recently published SIOG Top Priorities Initiative for the advancement of care for older adults with cancer represent a good starting point to understating the types of initiatives needed both in high income and in low and middle income countries. Likewise, UICC has developed a series of materials, framed within the United Nations Decade of Healthy Ageing, which include Roundtable Discussions and Special Focus Dialogues. These highlight the changes needed to adapt healthcare systems and to develop successful advocacy programmes in geriatric oncology.
While population ageing and the increasing cancer burden associated with it may seem like enormous challenges, they also represent an exciting opportunity to improve the way we deliver care for older adults with chronic diseases such as cancer. We already know what the priorities are, as well as what is needed to increase the geriatric competence of the workforce and to create age-friendly healthcare systems. Now it is up to us healthcare providers, policy makers, patient advocates, and global organisations to take on the implementation of these initiatives globally so that older adults with cancer get high quality, patient-centered care, regardless of where they live.