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With life expectancy continuing to rise and the rapid pace at which the population of older adults is growing, the American Society of Clinical Oncology (ASCO) is warning that we will soon face a “silver oncologic tsunami”.
According to the National Cancer Institute (NCI), nearly three-quarters (73%) of cancer survivors in the United States will be over the age of 65 by 2040.
In the UK, the number of people living with a cancer diagnosis is set to double from more than 2 million in 2010 to 4 million by 2030, with nearly one in five (19%) people aged 65 and over predicted to have had a cancer diagnosis in 2030. This has risen from 13% in 2010.
Andrew Chapman, director of the Sidney Kimmel Cancer Center, is now calling for the implementation of geriatric oncology programmes which would teach clinicians how to adopt a team approach to cancer care for senior adults.
The importance of geriatric assessments
Ahead of the 2023 ASCO Annual Meeting on 4 June, Mr Chapman said: “We have a responsibility in this country to meet the unique needs of older adults with cancer, and we need to do that by developing geriatric oncology programmes, both large and small, across the country.”
For this reason, ASCO’s Annual Meeting featured an education session held by presenters with experience implementing geriatric oncology programmes and overcoming common challenges.
The speakers, Mr Chapman, Dr Tina Hsu (MD, FRCP, of The Ottawa Hospital in Ottawa, Ontario, Canada) and Rawad Elias (MD, medical director for geriatric oncology at Hartford HealthCare Cancer Institute) have spoken extensively about the importance of geriatric assessments (GAs), and how they can decrease toxicity from systemic therapy, improve completion of chemotherapy, and reduce hospitalisations in older adults with cancer.
GAs also offer patients a chance to speak about their personal wants and needs. For example, older patients may prioritise maintaining independence (such as driving, spending time with family and engaging in hobbies) rather than seeking curative treatments.
“Given the ageing of the cancer population, this has the potential to have a positive impact on the care of a large swath of patients seen,” they wrote in a recent paper.
However, a lack of knowledge, time, and resources has meant that uptake of geriatric assessments has been low.
“The guidelines are saying you have to do geriatric assessments, and the community is saying, ‘How do I do that? What resources do I need? Is this something only big academic centres can do? Or can regular community practices do this?’” Dr. Elias said.
Healthcare providers must avoid “dwelling on barriers”
The experts acknowledge that workforce shortages and a lack of geriatric training can make adopting these care models more challenging, but they say creating a business proposal that considers the resources required and addresses the benefits of such a programme can address these issues.
“Given the enormous potential impact of a cancer and ageing programme to improve outcomes of older adults with cancer and the adaptability of GA to multiple contexts and resource settings, healthcare providers and administrators should move beyond dwelling on barriers to implementing GA and work to address these challenges in order for older adults with cancer to have access to the highest-quality cancer care that matches their goals,” they write.
“Geriatric oncology is like the poster child of how we can tailor care to the supportive needs of our patients,” Dr. Elias said. “If we can learn how to do geriatric oncology right, we can use the same model, the same structure, to implement support for all our patients at any point in care, whatever their age is.”