Cancer is predominantly a disease of ageing. This is because cancer is caused by DNA mutations that are collected over time. For many reasons we are all living longer, and as a result cancer is becoming more prevalent. This is not rocket science and it means that many “elderly” people will be diagnosed with cancer.
So how helpful is it for Ciaran Devane, CEO of Macmillan Cancer Support, (@ciarandevane) and perhaps one of the most influential people in the UK to have a voice about cancer to say that elderly people with cancer in the UK are being “written off” and to blame “age discrimination and inadequate assessment methods” amongst those of us treating cancer as the reason.
Yes, that’s right, if you are someone who treats people with cancer you are being labelled as discriminatory.
Quite frankly I find it a little insulting, somewhat patronising, frustrating, and just plain wrong. But Macmillan have a job to do and fundamentally we are on the same side; we all want better outcomes for people with cancer.
The problem is that press releases and quotes such as this are picked up by the media and reported under headlines like: Too many needless deaths because elderly cancer sufferers ‘written off’. We can blame sensationalist journalism, and Laura Donnelly at The Telegraph should know better, but responsibility rests with Macmillan because they know how these things play in the media.
So why did Mr Devane decide to take a swipe at the hard-working cancer doctors in the UK? Well, in concert with the National Cancer Intelligence Network (NCIN), Macmillan has been looking at survival rates for cancers across age groups. They point out that more than 130,000 people in the UK have survived for at least 10 years after being diagnosed with cancer at 65 or over, and that more than 8000 of these people were diagnosed when over the age of 80.
This is really excellent news.
Where we as a country apparently fail is when our survival rates are compared to the rest of Europe. Using lung cancer as an example they state that for the under 45’s we (UK & Ireland) are only 9% worse that the European average, but the gap increases to 44% for the over 75’s.
Mr Devane’s conclusion is that the cause must be discrimination, but he offers no evidence. We know that comparing the UK with the rest of Europe is fraught with difficulty, including problems relating to socio-economic class, migration and overall societal health (see the excellent commentary on the EUROCARE-5 study by Alastair J Munro).
But is it fair of me to criticize Macmillan and Mr Devane without offering some objective data of my own? I think not, so here goes:
The Oesophago-gastric team at University Hospital Southampton (@UHSFT), where I work, looks after people with cancer of the oesophagus (gullet) and stomach. I think we do an important job because rates of oesophageal cancer in men in the UK have risen by 50% over the last 40 years, and are still rising. And we treat ‘elderly’ people. Since April 2011 the median age of the patients that I have operated on is 69. In fact, 60% of them were over 65 years old and 28% over 75. This is for an operation that involves opening the chest and abdomen and is associated with very high risk (I explain in the video at the bottom of the link), even in the youngest and fittest. These figures are backed up by the National Oesophago-Gastic Cancer Audit (NOGCA) 2013 that shows that the median age for treatment with pre-operative chemotherapy and surgery is 65 years. Furthermore, 8% of operations were performed in the over 80’s age group. Yes, patients who were treated with curative intent were younger, but importantly, they were also fitter. This is reflected in the fact that only about half of patients who started palliative chemotherapy treatment finished the prescribed course.
Put plainly, in oesophageal and gastric cancer we understand the demands of an elderly population and we base our decisions not on age alone. We are prepared to offer potentially dangerous procedures to elderly people if we as a team (including the patient) think it is the right thing for them as an individual.
So, Macmillan and Mr Devane, you are right, we should always be looking for ways to improve and in some case we could do better……..but so could you.