In the context of the current pandemic and related challenges in balancing the risks from exposure to infection and those related to discontinuity of treatment, older patients with cancer face an excess risk from both COVID-19 and under-treatment of pre-existing conditions. Older adults with cancer are also bound to be amongst the most susceptible to the collateral effects of the lockdown measures which, while meant to provide a shield from infection, also pose an unprecedented burden on the mental wellbeing of the isolated older population.
Given such cumulative risks related to both cancer and ageing, as well as to the possible presence of comorbidities, there are difficult clinical and ethical issues at stake to ensure the response to the pandemic does not reinforce ageist bias in society and magnify health inequalities at the expense of older adults. With age-related inequities already diffused in many countries’ pre-pandemic healthcare systems, there is an ethical imperative that medical decisions, public health policies and social restrictions being introduced in response to COVID-19 cater for the specific needs of the older population, taking into account its demographic, health and functional diversity.
In this Special Focus Dialogue, professionals concerned with cancer and ageing and representatives of cancer patients addressed the dilemmas faced by clinical decision-making and public health policies during the pandemic in order to preserve the highest standards of care and treatment for older patients with cancer, and looked at the lessons that can be drawn to enhance health systems’ responsiveness to the needs of older adults going forward.
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The doctor and gerontologist Alexandre Kalache is president of the International Longevity Centre Brazil and co-director of the Age Friendly Foundation. He holds a PhD in epidemiology from the University of Oxford, founder of the University of London's Epidemiology of Ageing Unit and creator of Europe's first Master in Health Promotion. He directed the Department of Ageing and Life Course of the World Health Organization (WHO), where he conceived and published, in 2002, the Political Framework for Active Ageing and, in 2005, the Age Friendly Cities initiative.
Antonella Cardone is the Director of the European Cancer Patient Coalition (ECPC), which is the largest cancer patient umbrella organisation in Europe with over 450 members from 46 countries. She has over 20 years of international activity in health, social and employment sectors. Prior to ECPC, Antonella was the Executive Director of the Fit for Work Global Alliance, a multi-stakeholder coalition championing change in health and work policy. She was previously Director of the Global Smokefree Partnership of the American Cancer Society.
Nicolò Matteo Luca Battisti is a senior clinical research fellow in medical oncology at the Breast Unit of The Royal Marsden NHS Foundation Trust. He trained at the National Cancer Institute of Milan and then spent a year at the Senior Adult Oncology Program of the Moffitt Cancer Center. In 2019 he started a research degree at the Institute of Cancer Research London on care for older adults. He is chair of the Young Interest Group of the International Society of Geriatric Oncology (SIOG), co-chair of the European Cancer Organisation (ECCO) Inequality Network and co-chair of the SIOG COVID-19 Working Group.
Enrique Soto Perez De Celis is a geriatric oncologist and researcher in the Department of Geriatrics at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. He currently serves on several ASCO committees, including the Annual Meeting Scientific Program Committee, Journal of Global Oncology Editorial Board, Conquer Cancer Grants Selection Committee, Diversity and Inclusivity Task Force and Technology Research Group. He received a 2019 Conquer Cancer Career Development Award.