Cancer disproportionately affects older adults, who require tailored prevention, treatment and support. With populations ageing rapidly worldwide, this paper examines the major challenges and how the cancer community can help drive progress for older populations.
The world’s population is ageing rapidly. There are currently over 703 million people worldwide above the age of 65 years [i], representing 9.1% of the global population. Estimates suggest that this proportion will rise to 15.9% (1.5 billion people) by 2050.
Population ageing will have consequences for cancer control globally as cancer is more prevalent in older adults. Cancer can develop at any age, but the incidence of cancer rises dramatically at a later stage in life.
In fact, more than 50% of people who have cancer are 65 or older (calculated from the GLOBOCAN 2020 data). This is most likely due to the accumulation of risk factors for specific cancers, which increase with age and less effective cellular repair mechanisms. (Source: WHO)
With the increase of ageing populations and incidence of cancer worldwide, more practical research and action need to take place to adapt healthcare systems to be more patient-centric and inclusive of ageing populations to ensure healthy ageing for all.
Age adds a layer of complexity to living with cancer. Many cancers in older people are diagnosed at a later stage, as early cancer symptoms can be mistaken for everyday pain or minor illnesses associated with old age. As a result, cancer treatment often starts late, which increases the likelihood of side effects and reduces the chances of a successful treatment outcome.
An opinion poll covering 20 countries conducted by UICC via Ipsos showed that in comparison to younger age groups, people above 50 years old were more likely to say that they have not done anything in the past 12 months to reduce their risk of cancer. Conversely, they comprise the most likely age group to have participated in a cancer screening in the past 12 months – particularly women over 50 years of age. This is consistent with global guidelines for screening, which call for these groups to be screened more than those aged under 35.
Furthermore, the treatment of older patients with cancer presents a number of unique challenges as older adults are more likely to suffer from other chronic conditions and non-communicable diseases, such as high blood pressure or diabetes. This makes cancer treatment more challenging.
Older patients are also often more vulnerable to treatment toxicities that can significantly affect their quality of life (Source: ASCO). Therefore, treatment plans should be built on a geriatric cancer assessment, which brings together a patient’s preferences and capacities and expert support from a multidisciplinary team, in order to deliver care and maintain an individual’s quality of life.
These and other age-specific aspects need to be taken into consideration when defining the cancer care approach.
Unfortunately, the increase in the number of older people living with cancer has not been mirrored by a proportional increase in public awareness of the burden, or by investments in the health services required to respond to the unique needs of this group. Some of the key challenges are:
The topic of ageing and cancer will grow in importance in the next decades and UICC is committed to raising awareness of how best to prepare healthcare systems, so that cancer care challenges for older patients are appropriately addressed.
To this effect, UICC is partnering with Sanofi on the When Cancer Grows Old initiative.
Through UICC's Technical Fellowships programme, learning and training opportunities are available for cancer professionals working in geriatric oncology through one-month international visits.
In-depth exchanges with UICC members and the broader cancer community are being held as part of UICC’s new Virtual Dialogues.
In the Ageing and Cancer series: #1 Caring for older cancer patients during COVID-19 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.
Go straight to the key insights and outcomes of the Dialogue with this summary brief:
In the Ageing and Cancer series: #2 Reshaping cancer control for ageing societies, following the Special Focus Dialogue on Caring for older cancer patients during COVID-19, this second discussion in the Ageing and Cancer series brings together key experts from international bodies, government, academia and public health to take the ‘long view’ on reshaping cancer control for the needs of ageing societies.
At the same time, UICC is working to promote the inclusion of cancer care for older patients on the global policy agenda and to ensure that core messaging on the needs of older cancer patients is integrated into key plans and resources on cancer and Universal health coverage (UHC), WHO’s Decade of Healthy Aging (2020-2030) and national cancer control planning.
[i]United Nations, Department of Economic and Social Affairs, Population Division (2019) World Population Ageing 2019, Highlights. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf (accessed 25 March 2020)
[ii]Adapted from 2020 SIOG priorities