Exploring patient-centred care at every age

Age is one of the leading risk factors for cancer. Each year, nearly 10 million older adults are diagnosed with cancer: cancers amongst the over-65s account for 51% of the global cancer burden and 59% of global cancer mortality. In many ways, however, older adults with cancer continue to be considered and treated as a niche population.

Just over half of cancers in older adults currently occur in high-income countries. However, the rapid demographic transition taking place in low- and middle-income countries is likely to result in an equally rapid increase in cancer cases there. 

At the same time, while in the last 30 years health policies and programmes have helped to extend average global life expectancy from 64.2 years in 1990 to 72.6 years in 2019, these extra years are not being lived in good health. 

We are seeing more adults of all ages living with one or more health conditions and which makes the successful treatment of conditions like cancer more complicated. As a result, governments and health systems are facing the double challenge of responding to both a growing population of older adults and a population with more complex health needs.  

In a report published today, Exploring the challenges to patient-centred cancer care at every age, UICC, the NCD Alliance, the European Cancer Patient Coalition and the International Society for Geriatric Oncology identify some of these challenges spanning the full spectrum of cancer control. 

Within the policymaking arena, the limited availability of data on the prevalence of co-morbidities and the costs associated with this lack of data has contributed to policies being developed and implemented in siloes. This also means that policymakers are making important decisions with partial information and may be missing out on opportunities to better integrate services for older adults and those with co-morbidities (who present more than one disease or condition at the same time) . In turn, this means that many of the investment cases miss out on the added benefits that integrated care may have for patients, communities, health systems, and economies. 

From a clinical perspective many older adults, and particularly those who suffer from co-morbidities struggle to receive the care they need. There are shortages of trained healthcare staff, limited guidance for the diagnosis and management of cancer and other NCDs in older adults, as well as the physical fragmentation of health infrastructure. In effect, this means that patients may be required to visit multiple different facilities for each separate disease or condition, increasing the costs associated with seeking care and putting additional physical demands on potentially frail individuals. 

Underpinning both sets of issues is the prevalence of ageist beliefs and attitudes, which continue to downplay the importance and value of investing patient-centred services for older adults. 

Highlighting these issues and looking ahead to the COVID-19 recovery and continuing efforts to deliver UHC, the report Exploring the challenges to patient-centred cancer care at every age identifies a number of core strategies to help drive improvements: 

• Take a person-centred approach to health by understanding the challenges faced by older adults and those with co-morbidities and address these through national health strategies. 
• Collect data on the prevalence of co-morbidities and support research to understand the impacts on individuals, health systems and economies. 
• Ensure financial and social protection measures include older adults and those with co-morbidities 
• Integrate care for older adults into medical education and research. 

The report is being presented at the UICC Special Focus Dialogue held on 30 September, entitled “Patient-centred cancer care at every age: what can we do in the next 10 years?”