‘Silver tsunami’ of older cancer patients to hit NHS

The aging population in the UK will increase the number of cancers by a third over the next two decades.

The number of deaths is expected to rise by a quarter, with six in ten diagnoses being made in people over the age of 70 – a fifth higher than current levels.

A gathering of 40,000 cancer experts this weekend warned that health systems are woefully underprepared for the trend, which is mirrored worldwide.

They urged ministers to take action now to address the shortage of cancer specialists, or said unnecessary lives will be lost to the disease.

Complicating the situation further is that older patients typically have multiple health problems and require more complex care, they said.

Dr. Andrew Chapman, a leading geriatric cancer specialist at Thomas Jefferson University Hospital, Philadelphia, said without urgent action, older patients “will receive suboptimal care.” He said the treatment of retirees was often “nihilistic” and told health leaders to ensure “age discrimination is not acceptable.”

Speaking at the American Society of Clinical Oncology in Chicago, he said, “The point behind the silver oncology tsunami is that as the population grows and the incidence increases a lot, are we really prepared to meet those needs? I think we are not global.’ He added: “Sometimes there’s a nihilism – ‘when you’re older, we’re not going to bother’ – which is awful.

Age is not that relevant. The point is how physically fit you are and not everyone of the same age is equally fit. So that’s not fair…”

He said health services needed to train more people to meet the demands of older patients, which are typically very different from young people.

Treatment should be based on the wishes of the individual patient rather than following a universal approach.

“It has to be a shared discussion to say, ‘This is really what my goals are, this is what I’m trying to achieve,'” he said.

“Usually, older adults care more about maintaining their function than about the cancer. They want to go to weddings, they want to see their grandchildren, they want to play golf.

“If you’re going to give someone a treatment that takes that away, they might not want that.

“It’s very different from a 45-year-old who wants to live another 40 years. It’s a different game.’

Dr. Tina Hsu of Ottawa Hospital in Ottawa, Ontario, Canada, said alongside him that “the time is right” to develop services for geriatric cancer.

She said multiple studies had shown “a tangible benefit to our patients” by considering measures such as frailty before starting treatment.

She said: ‘I think there is an urgent need to implement their knowledge in the care of our patients so that our patients can benefit from what we know.

“We are already at the point where we are seeing more and more older adults with cancer. It’s not something like that [is] is going to happen in the future.. I think it’s happening now. And so there is urgency.’

Cancer Research UK estimates that the number of cases will reach half a million a year by 2040 for the first time.

Overall, there could be 8.4 million new cancer cases and 3.5 million cancer deaths in the UK between now and then.

Professor Charles Swanton, chief medical officer for Cancer Research UK, reiterated concerns about the UK’s preparations.

Older cancer patients often have comorbidities and other illnesses such as cardiovascular disease, heart or breathing problems, he said, that can affect treatment.

‘These patients use multiple medications and tolerate chemotherapy less well, they are often weaker. So they require much more diligent medical management.

‘The question is, how does the healthcare system deal with this?

“We now have a staffing problem with about 384,000 cancer cases a year, which is expected to rise to more than half a million by 2040.

“We already have a major challenge with staffing in the NHS, and that’s combined with an increasing exodus of healthcare doctors who are either moving to another job or leaving the country.”

While survival rates have improved, the UK is lagging behind much of Europe, with record waiting times doing little to reverse that trend.

Strikes by nurses, junior doctors and paramedics have added to the disruption caused by the Covid and flu season, causing more than 500,000 appointments and surgeries to be postponed.

A report from the Royal College of Radiologists found a 17 per cent shortage of clinical oncologists by 2021, meaning the UK was short of 189 trained specialists.

It also suggested widespread regional disparities for older patients, with those in London having access to three times as many cancer specialists as people in parts of Wales and the East Midlands, at 9.6, 3 and 4.5 per 100,000 people respectively.

Dr. Julie Gralow, ASCO’s Chief Medical Officer, said: ‘Cancerous workforce shortages are a global concern, and those workforce concerns become particularly pressing when you consider the growing number of older adults and the fact that the risk of on cancer increases with age.

“Current gaps in the global oncology workforce need to be addressed.” Last night, charities repeated calls for more specialist doctors to treat elderly patients.

Caroline Abrahams, Charity Director at Age UK, said: ‘To meet increased demand, this means the NHS needs more clinicians, especially more geriatricians – advisers who understand the health of older people in the round.

“These skills are especially important because we know that many older people with cancer also manage other long-term health problems, and they need treatment and support that takes into account how these different issues interact in our aging bodies.”