‘Silver tsunami’ of elderly cancer patients could overwhelm NHS

The NHS faces an imminent “silver tsunami” of geriatric cancer patients which threatens to overwhelm unprepared health services, leading scientists and doctors have warned.

Doctors have warned that unless more can be learnt about how cancer affects patients of different ages, medicine will fail the country’s ageing population.

Dr Andrew E. Chapman, director of Jefferson Health’s Sidney Kimmel Cancer Center in Philadelphia, believes a “silver oncology tsunami” is on its way and doctors are not ready.

“The point behind the silver oncologic tsunami is that as the population expands and the incidence [of cancer] goes way up, are we really prepared to deal with those needs? I think globally, we’re not prepared,” he told reporters at the American Society of Clinical Oncology annual conference in Chicago.

Older cancer patients have unique needs, he said, and experts have a responsibility to improve geriatric services in order to provide suitable care.

Scientists said that doctors struggle to treat older cancer patients who often have other pre-existing health conditions, but global workforce shortages mean that care is not improving.

Medication to treat various ailments also makes it hard to create a bespoke course of treatment for geriatric cancer patients.

More nuanced treatment plans needed for the elderly

Prof Adam Gordon, president of the British Geriatrics Society, said treatments for elderly oncology cases exist, but the difficulty is in their application.

“We can offer anti-cancer therapies to older people with multiple health problems or frailty, but before we can do so it’s important that patients are assessed fully, taking account of any long-term conditions, disabilities, frailty, and how these affect their daily lives,” he said.

“This can help us make more balanced treatment plans taking account of the likely benefits and harms.”

He added that these more nuanced cancer plans will likely include changes to medications as well as recommendations about diet, exercise or home adaptations, instead of the default treatments that work well in younger patients.

Dr Tina Hsu of the Ottawa Hospital in Ontario, Canada, said that without fully understanding gerontology there is a danger that patients may be subjected to inappropriate treatments.

“If we aren’t assessing patients then we’re going to be over-treating some people and exposing them to unnecessary toxicity,” she said.

‘There’s also a component of nihilism’

“I also think that there’s a component of - I hate to say it - but there’s a component of maybe nihilism a little bit.”

Prof Chapman agreed, saying: “Sometimes there’s a nihilism - ‘if you’re older we’re not going to bother’ - which is horrible.”

Cancer Research UK estimates there will be more than half a million people diagnosed with cancer in Britain every year by 2040.

Within 20 years the annual cancer death toll will be in excess of 200,000, the charity’s analysis claims, and 3.5 million Britons will die of cancer between now and 2040.

The majority of cases are expected to be in over-70s while three-quarters (76 per cent) of deaths will be in this age group.

Prof Charles Swanton, the charity’s chief clinician, said: “By 2040 there will be a 33 per cent rise in the number of cases, a 25 per cent rise in the number of cancer deaths, and six in 10 of those diagnoses will be in people over the age of 70 as opposed to five in 10 now.”

Older people are also more likely to have other health conditions than younger cancer patients, as most diseases, not just cancer, increase in likelihood with age. These often include diabetes, respiratory issues and cardiovascular conditions.

The various drugs and medications pensioners take for co-morbidities make cancer treatment harder in geriatrics than for the rest of the population.

“Diseases of ageing are obviously more common among 70-year-olds than in 40-year-olds and, as a result, polypharmacy is a problem too,” Dr Swanton explained.

“These patients are on multiple drugs and their ability to tolerate chemo is less good, they are often weaker. So they require much more assiduous medical management.”

Government urged to prioritise staffing

Caroline Abrahams, charity director at Age UK, said the UK Government needs to prioritise staffing in order to ensure it is best placed to combat a cancer surge in the elderly.

“To manage the increased demand this represents the NHS will need more clinicians, especially more geriatricians - consultants who understand older people’s health in the round,” she said.

“The geriatrician’s skill set is particularly important because we know that many older people with cancer are managing other long-term health conditions as well, and they need treatment and support that takes into account how these various problems interact in our ageing bodies.”

Prof Paul Pharoah, professor of cancer epidemiology at Cedars-Sinai Medical Center in New York, said the anticipated cancer spike in the over-70s “will bring major challenges for health care services”.

“Not just because the number of people needing diagnostic and treatment services will increase, but also because the management of older patients is often more complex.”

A Department of Health and Social Care spokesperson said: “There are more doctors, nurses and staff working in the NHS than ever before, with 50 per cent more specialist cancer doctors treating patients now compared to 2010.

“The NHS is also seeing, treating and saving record numbers of people with cancer but we know there is more to do.

“That is why we are seeking views on our Major Conditions Strategy and the NHS will soon be publishing a long-term workforce plan setting out how it will recruit and retain even more staff.”

An NHS spokesperson said: “We know we have a growing and ageing population, which inevitably increases the number of people needing NHS care and the intensity of support they require, and as set out in the NHS Long Term Plan we are working with partners to ensure doctors are trained with the generalist skills needed to meet the needs of an ageing population, alongside the development of specialist knowledge and skill.

“The NHS is seeing and treating record numbers for cancer, and a higher proportion of people are now being diagnosed at an early stage than ever before - identifying people with cancer as early as possible when it is easier to treat is an absolute priority, and NHS staff continue to roll out initiatives to reach as many people as possible, from cancer awareness campaigns to lung scanning trucks, which have already caught hundreds of cancers earlier.”