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Background

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Cancer is predominantly a disease of older people. With an ageing population, this poses a major challenge to healthcare systems. In 1985, around 15% of the UK population was over the age of 65, but by 2010 this proportion had increased, by an additional 1.7 million people, to 17% of the population.1 This trend is set to continue, and it is projected that by 2035 more than 23% of the population will be over 65.1

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Cancer incidence is highest in older people, with 63% of all cancers diagnosed in those aged 65 or over.2 Figure 2.1 shows the increasing incidence of cancer in individuals aged 65 and over between 1971 and 2009. It is anticipated that there will continue to be large increases in the number of older people diagnosed with cancer over the forthcoming decades.2 By 2040, it is estimated that almost a quarter of people over the age of 65 will have experienced the disease (amounting to 4.1 million people).3 As such, ensuring that high-quality services are available to care for this rapidly growing population is a major challenge for healthcare providers.

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Figure 2.1

Registrations in England, between 1971 and 2009, of newly diagnosed colorectal, lung and prostate cancers in men, and of newly diagnosed colorectal, lung and breast cancers in women (adapted from Sinha et al.56).

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The scale of the challenge is compounded when it is considered alongside current concerns that those diagnosed in older age groups are experiencing inequalities and inequities in both their care and prognosis.4-6 These anxieties have been heightened by international comparisons repeatedly showing that the 5 year cancer survival rates attained in the UK lag behind those of many economically comparable countries, due to poorer outcomes for older patients.7-11 There is also a growing body of evidence suggesting that older patients are undertreated and do not have access to the best care.7 Improving outcomes for older patients has, therefore, become a priority; but, before steps can be taken to reduce the deficits, it is important to understand how they have arisen. The available evidence suggests that a number of factors, across the entire care pathway, may be responsible.

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Diagnosis and presentation

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First, there appear to be differences in relation to diagnosis and presentation.6,12 The best outcomes for solid tumours are achieved when individuals are diagnosed with early-stage disease.13 It is unfortunate, therefore, that it appears that a greater proportion of older patients present with advanced disease compared with younger patients.14,15

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A greater proportion of older patients also present as emergencies.16 A national population-based study of all cancer patients over a 5 year period in England identified that 15% of those under the age of 50 ...

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