If you asked the general public to name the leading causes of cancer, most would point to smoking, excessive alcohol consumption, or sun exposure. However, groundbreaking analysis reveals that the single most significant risk factor for developing cancer is an inevitable process we all face: ageing.
The Unavoidable Demographic Shift
This revelation carries profound implications for healthcare systems worldwide, particularly in nations like the UK with rapidly ageing populations. The demographic shift towards an older society means that a larger proportion of citizens will be living with a cancer diagnosis. With cancer already ranking as one of the most prevalent diseases among older adults, healthcare providers must urgently adapt to deliver appropriate care for this growing demographic.
Current performance in addressing this need is lacking, according to experts. International guidelines, including those from the American Society of Clinical Oncology, recommend that all older adults undergo a geriatric assessment before deciding on cancer treatment. This comprehensive evaluation, ideally conducted by a geriatrician, provides crucial information about how treatments might affect a patient's cognition, physical function, existing health conditions, and overall quality of life.
The UK's Geriatric Oncology Gap
Specialised geriatric oncology clinics remain scarce across the UK, mirroring the situation described in Canada. Pioneering clinics like the one at the Jewish General Hospital in Montréal and the Older Adult with Cancer Clinic at Princess Margaret Cancer Centre in Toronto demonstrate the model's success. Research led by Professor Shabbir Alibhai has shown that these clinics can generate substantial cost savings—approximately £5,500 per older adult—representing significant potential savings for public health systems like the NHS.
Despite this compelling evidence, geriatric assessment is not yet routine care. In regions like British Columbia, where no specialised services exist for older adults with cancer, researcher Kristen Haase has spent five years documenting the pressing need for such support. Her team conducted extensive interviews with over 100 members of the cancer community, including patients, caregivers, volunteers, and healthcare professionals. The consensus revealed an overwhelming desire for better support systems tailored to older patients.
Overcoming Barriers to Better Care
Several significant barriers prevent the widespread implementation of specialised geriatric oncology services. While cost might seem an obvious hurdle, evidence suggests that initial investments would be offset by long-term savings through more targeted and effective care.
The shortage of geriatricians presents another challenge, though innovative solutions exist. Nurse-led models have proven successful and could be expanded, particularly with the growing role of nurse practitioners in the UK healthcare system.
Perhaps the most entrenched obstacles are systemic inertia and ageism. The oncology care model has remained largely unchanged for decades, primarily revolving around a single physician. Implementing comprehensive approaches like geriatric assessment requires more fundamental changes than introducing new medications or surgical techniques.
Furthermore, age-based discrimination subtly influences healthcare priorities. As one expert noted, society would never accept a scenario where children with cancer couldn't access paediatric specialists, yet similar gaps in care for older adults often go unchallenged.
Looking forward, it may not be feasible for every older adult with cancer to receive specialised geriatric services. However, healthcare systems can innovate by stratifying care to target those who would benefit most—typically the frailest patients whose quality of life stands to improve significantly through tailored approaches. Such targeted programs would also maximise financial efficiency, creating a compelling case for healthcare policymakers prioritising both patient outcomes and cost-effectiveness.
