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Introduction

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NHS cancer services are improving. We are diagnosing more patients before their cancer has spread and providing more effective treatments delivered by expert teams. The experience reported by patients is increasingly positive and we know more about how to support people in living well after a diagnosis of cancer. There is much reason for encouragement and it is right that we celebrate the progress that has been made. Yet there is no room for complacency. Our outcomes are still not as good as in some national comparator countries, and the needs of cancer patients are changing. Worryingly, our outcomes appear to be poorer in the demographic group in which cancer will increase the most: older people. Cancer is predominantly a disease of older age and our population is ageing. More people will be diagnosed with cancer and their needs will be more complex.

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Nearly two-thirds of cancer diagnoses occur in the over-65s and one-third in people aged 75 and over. In 2012, over 102,000 people over the age of 75 were diagnosed with cancer. Nearly 32,000 of them were over the age of 85.1 By 2020 there will be nearly two million people aged 65 and over alive following a diagnosis of cancer. The growing impact of cancer in older people is reflected in the demand for cancer services. More than a quarter of all admitted episodes for cancer in England occur in the over-75s.2 In the past decade, the increase in admissions in this group has far outstripped the increase observed for cancer patients of all ages.

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Today's cancer services, however, were largely designed in the 1990s, a time when the average age of cancer patients was significantly younger. We are now faced with a choice: we can seek to perfect the existing model of cancer care or we can redesign cancer services to better meet the needs of older people. We firmly believe that we must take the latter approach, both so that we may achieve the best outcomes and make the best use of the resources available to us.

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The needs of older people are not uniform, just as they are not for any group in society. The nature of malignancy, socioeconomic status, sex and ethnicity all play a role in shaping people's needs and outcomes. Equally, the needs of active older people in otherwise good health will be very different from those of people living with frailty and other health conditions. Yet there is evidence to suggest that older people appear to experience poorer outcomes. Older people are more likely to be diagnosed with cancer following an emergency admission, which diminishes their chances of long-term survival. They also experience poorer survival after diagnosis with a cancer that has already spread. Seeking to make earlier diagnosis in older people should be a major priority. We need to increase awareness of signs and symptoms of cancer, but we also ...

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