The leading risk factor for cancer is not smoking, alcohol, or sun exposure, but rather something far more insidious and unavoidable: ageing. This revelation should be a wake-up call for healthcare systems worldwide, especially as the global population of older adults continues to grow at an unprecedented rate. By 2068, approximately 29% of Canadians will be over the age of 65, and with cancer being one of the most prevalent diseases in this demographic, it's high time we reevaluate our approach to cancer care for the elderly.
The Geriatric Assessment: A Missing Link
International guidelines, including those from the American Society of Clinical Oncology, recommend that all older adults undergo a geriatric assessment before cancer treatment decisions are made. This assessment, typically conducted by a geriatrician, provides a holistic view of the patient's health, considering factors like cognitive function, physical abilities, existing illnesses, and life expectancy. What makes this approach truly remarkable is its patient-centered nature, ensuring that treatment plans are tailored to the individual's needs and wishes.
However, the implementation of geriatric assessments is far from universal. In Canada, specialized geriatric oncology clinics are few and far between. The Jewish General Hospital in Montréal and the Older Adult with Cancer Clinic at Princess Margaret Cancer Centre in Toronto are among the pioneers in this field. Despite the demonstrated cost savings and improved patient outcomes, these services are not yet widely available.
Barriers to Care: Cost, Resources, and Inertia
The absence of widespread geriatric oncology services can be attributed to several factors. Cost is a significant barrier, but with evidence of cost savings, it's a non-issue. The real challenge lies in the shortage of geriatricians and the expanding role of nurse practitioners, who could potentially fill this gap at a lower cost. Inertia within the healthcare system also plays a role; the traditional physician-driven model of care has been slow to adapt to new, more holistic approaches.
Ageism: The Hidden Barrier
Perhaps the most insidious barrier is ageism, the discrimination based on age. We would be outraged if children diagnosed with cancer couldn't access pediatricians, yet we accept this for older adults. The overwhelming number of elderly individuals diagnosed with cancer in the coming years means that specialized geriatric services will never be universally available. However, there is an opportunity to innovate and target care to those who need it most: the frailest and most vulnerable.
A Call to Action
The time has come to prioritize cancer care for older adults. By implementing geriatric assessments and expanding specialized clinics, we can improve the quality of life for these patients and reduce the financial burden on healthcare systems. Cost savings, improved patient outcomes, and the potential for innovation should be enough to convince decision-makers to take action. It's time to break down the barriers of cost, resources, and inertia, and confront the hidden barrier of ageism head-on. Only then can we ensure that cancer care for older adults is as comprehensive and effective as it should be.
