Skip to main content

Poor Health Outcomes of Older Cancer Patients in the UK: Is Age Discrimination at Play?

Age discrimination can have many negative effects on the livelihoods of older people. Among these effects are poor health outcomes in older Britons suffering from cancer, according to a recent report from the King’s Fund, a health think tank, and Cancer Research UK.

In 2004-2005, England was spending close to £4 billion on cancer care, its 4th largest health expenditure among 24 health conditions. Although England’s healthcare spending is similar to other European countries, its health outcomes are worse in older adults with cancer. The report titled “How to improve cancer survival: Explaining England’s relatively poor rates,” looks at why poor health outcomes exist among cancer patients.

The report shows that cancer survival rates in England are worse than in other countries due to late diagnosis, delayed treatment, and under-treatment in the older patient population. Age is considered an influential factor in delaying cancer diagnosis, and older cancer patients reportedly receive less evaluation by cancer specialists. When they do, they are oftentimes offered fewer treatment options as a result of “age bias”.

Is age bias reflective of the values system in England and of the National Health System, and thus, is it responsible for the disproportionate rate of deaths due to cancer among older persons? Perhaps it is not age bias alone driving the poor health outcomes of older cancer patients, but maybe patients are choosing not to receive screening and non-standard treatments and clinicians are choosing not to offer these healthcare options due to the high rate of comorbidities and low life expectancies within this patient population.

The salient issue here is not whether older patients are receiving cancer screenings and treatment offered their younger counterparts, but whether they may actually benefit from these procedures. Would a frail 78-year-old woman with urinary incontinence and moderate cognitive impairment benefit from a mammography? Is age a discriminating factor associated with preventable deaths among older cancer patients?

The answers to these questions vary, depending on the source. The literature on benefits and burdens of cancer screening and treatment in older persons is contradictory at best. Below is a sampling of a handful of studies presenting diverse perspectives on the issue:

  • A 2001 U.S. retrospective observational study showed that among 216 older women (mean age of 81 years) receiving mammographies, only 2 (0.9%) may have benefited from the screening. 42% experienced pain or psychological distress as a result of the mammographies.

  • A 2007 systematic review by researchers in Switzerland suggests that older cancer patients with breast or gynecologic cancers are often undertreated, the effect of which is decreased prognosis. Age and comorbidities were found to be determining factors for undertreatment in older patients, with reportedly few studies actually focusing on the health effects of undertreatment.

  • A 2007 literature review from Italy looking at the correlation between colonoscopy and life expectancy found that although the rate of colorectal polyps detection in patients 80 and older was higher (29%) than the 50-54 (14%) and 74-79 (27%) age groups, life expectancy gain was smaller in the oldest age group (one and a half months compared to 10 months in the youngest age group).

  • A 2008 observational study from Spain found that among older patients with non-small cell lung cancer co-morbid conditions was more important than age in influencing treatment options.

    After reading these articles and several others of similar topic, the resounding bottom line seems to be that it is more important to focus on individualized geriatrics care than to generally promote screenings and non-standard treatments for older cancer patients.

    Findings from the King’s Fund cancer report will serve to galvanize the British government to improve geriatrics care, especially as it pertains to cancer screening and treatment for older persons. However, the question remains, will these efforts to endorse cancer screening and treatment among older persons outweigh the negative effects in practice?

By: Julie N. Thai [GeriPal International Correspondent]


Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Language Matters: Podcast with Brian Block and Anna DeForest

One of our first GeriPal posts was titled "Rant on Terminology," by Patrice Villars, NP.  In the spirit of looking back over our first 10 years, here is the opening paragraph to that post:

News Headlines read: Sen. Edward Kennedy loses battle with cancer. Really, he lost? I thought he died from a malignant brain tumor, an “aggressive” brain tumor. The median survival is less than a year for people for his particular tumor. Kennedy was diagnosed in May of 2008. He lived over 15 months after diagnosis. What a loser. He must not have fought hard enough. Huh? I thought he spent most of his life battling for social and health care reform in America. In this week's GeriPal podcast we take a deeper dive into this issue of language and medicine.  We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.  

Anna recently published a paper in the NEJM describing her reaction to hearing terms like, &…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …