Unveiling the Surprising Truth: Ageing, the Unavoidable Cancer Risk Factor
When we think of cancer, our minds often jump to well-known culprits like smoking, alcohol, or excessive sun exposure. However, the leading risk factor for this disease is something far more universal and unavoidable: ageing. This revelation prompts a deeper exploration into the implications for healthcare systems, especially as the global population ages.
The Demographic Shift and Its Impact
The aging population is a global phenomenon, with older adults becoming the fastest-growing demographic. In Canada alone, by 2068, nearly one-third of the population is projected to be over 65. This demographic shift has significant implications for cancer care, as cancer is one of the most common diseases affecting older adults.
Current State of Cancer Care for Older Adults
The current state of cancer care for older adults is a mixed bag. While international guidelines recommend geriatric assessments for all older adults prior to cancer treatment decisions, this practice is not yet routine. In Canada, specialized geriatric oncology clinics are few and far between, with only a handful currently operating.
However, the few clinics that do exist have demonstrated significant cost savings. A study led by Shabbir Alibhai, one of the authors of this article, found that these clinics saved approximately $7,000 per older adult patient. This represents a huge potential cost savings for public health systems, yet these specialized services are still not widely available.
Barriers to Specialized Care
So, what's holding us back from implementing these specialized services across Canada and beyond? Cost is one barrier, but the evidence suggests that the cost savings outweigh the initial investment. Another significant barrier is the limited supply of geriatricians, who are in high demand. However, nurse-led models have shown promise and could be a cost-effective solution, especially with the expanding role of nurse practitioners.
The clinical care model in oncology has remained largely unchanged for decades, primarily driven by a single physician. While modern cancer therapies have advanced rapidly, changing the care model is a daunting task, particularly for strategies like geriatric assessments that require more complex implementation than a new drug or surgical technique.
The Role of Ageism
Perhaps the most challenging barrier to address is ageism, a form of discrimination based on age that is deeply ingrained in many of our systems. We would never accept a scenario where children with cancer couldn't access pediatricians, yet we seem to tolerate this for older adults. With the overwhelming number of older adults who will be diagnosed with cancer in the coming years, it's clear that not everyone can receive specialized geriatric services. However, there's an opportunity to innovate care models that target those who need it most.
Targeted Care and Financial Impact
By stratifying programs to focus on the most vulnerable and those who stand to benefit the most from tailored care, we can improve quality of life and have the greatest financial impact. Cost savings alone should be a compelling argument for decision-makers, especially when combined with the personal stories of improved quality of life for older adults with cancer.
Conclusion
As we navigate the challenges of an aging population, it's crucial to address the leading risk factor for cancer: ageing. Specialized geriatric oncology services have the potential to revolutionize cancer care for older adults, improving quality of life and reducing costs. While there are barriers to implementation, the benefits are clear and the need is urgent. It's time to prioritize innovative care models that meet the unique needs of older adults with cancer.
