Q&A: The importance of ‘age-attuning’ national cancer control plans

As global life expectancy increases, the public health threat posed by cancer also grows. While the disease can develop at any age, the incidence rate rises in the later stages of life, with more than half of people with cancer being 65 or older. With the World Health Organization predicting that the number of people over 60 years will nearly double by 2050, the aging population will put increased demand on health services around the world.

Yet conversations around cancer and aging and support for the development of dedicated services needed to care for older adults with cancer, have been slow to develop.

There are still a lot of misconceptions around cancer in older people, despite that being the main demographic that oncologists have been treating for the past three decades, said Dr. Nicolò Matteo Luca Battisti, oncologist and president of the International Society of Geriatric Oncology, or SIOG. The level of care that older patients receive could also be greatly improved through a more holistic multidisciplinary approach, he added.

Battisti would like to see more “age-attuned” cancer care, meaning treatment plans focused on the specific needs of older patients with cancer. This would involve resource investment and training and upskilling opportunities for cancer care and other health care professionals. Speaking to Devex, Battisti shared his view on why this is not only the ethical thing to do but more sustainable in the long run.

This conversation has been edited for length and clarity.

How can we start to change mindsets and improve awareness of cancer in older people?

The answer is very complex and needs to involve different actions. We need to increase awareness among health care professionals — and specifically, the cancer workforce — that aging in cancer care is everybody's business. Over half of the cases we see in the clinic involve people over the age of 65 years old, and 70% of mortality involves people over that age, but there are still a lot of misconceptions around this. We also need to increase awareness among policymakers because the general population is aging, and this is something that we will increasingly need to address in the next few decades.

It’s also important to inform policymakers and health care professionals of all the benefits that are attributed to age-attuning cancer care. For example, reduction in complications of cancer treatment, reduction in hospitalizations, and a better quality of life for patients. Based on data that come from large randomized clinical trials, integrated oncogeriatric care may also be more sustainable because if we manage aging more proactively, then we can also save resources and money that can be reinvested to age-attuned cancer services.

Finally, and something I feel very strongly about, is that age-appropriate care is ethical. Aging is embedded in our DNA and looking after the most vulnerable groups of our general population, including the elderly, is the right thing to do.

Do older people living with cancer usually receive the care they need?

Unfortunately, most older patients with cancer don’t receive the care they need, which ideally would be multidisciplinary and holistic. Traditionally, multidisciplinary teams in oncology involve medical oncologists like me, radiation oncologists, surgeons, nurses, pathologists, and radiologists. But older patients with cancer also need the input of additional professions. Nurses are crucial, but also allied care professionals, such as physiotherapists, occupational therapists, dietitians, speech and language therapists, supportive care teams, and pharmacists — these are all experts that can provide a lot of good input on the management of older patients.

Where available, geriatricians are crucial to involve in routine cancer care as well. Managing cancer in older patients can be very complicated, and those who are more vulnerable derive significant benefits from this multidisciplinary input.

The current World Cancer Day campaign is all about closing care gaps. Where do you see the priority when it comes to caring for older cancer patients?

There are four priority areas that SIOG has been promoting for more than 20 years. Education is critical because we need to make sure that, for example, geriatrics and geriatric oncology are embedded in the training curricula of the cancer workforce, including medics, nurses, and allied care professionals. And we need to make sure that we provide education opportunities to upskill the existing cancer workforce in the principles of geriatrics. We also need to increase awareness among the general public because older people need more support to be heard and listened to.

Regarding clinical practice, we need to develop and implement models to provide optimal care for these patients. Again, these should be multidisciplinary holistic models involving additional professionals. The geriatric oncology community should also provide clinicians with recommendations based on a critical review of the evidence available to better inform the management of cancer in the older age group. We also need to create at least one center of excellence in geriatric oncology for each country.

The third priority is research. We need to conduct research to expand the evidence base because there are still very significant gaps of knowledge on the management of cancer in older adults and improve the recruitment of older patients in clinical trials in oncology.

And finally, collaboration is key. In order to raise awareness on the importance of addressing the needs of older adults with cancer, we need to work with international stakeholders, specialized agencies, professional organizations, policymakers, and patient advocacy groups to really spread the word and to inform national cancer control plans.

The magnitude of the problem can seem insurmountable, but have you seen progress in recent years?

I've seen huge progress over the past 20 years in the field of geriatric oncology, which started in the late 1980s and early 1990s. Since then, we have seen amazing research being conducted on the impact of an integrated oncogenic approach on our older patients with cancer. Randomized clinical trials have recently demonstrated that we can make systemic or drug treatment safer for all patients with cancer. And when we integrate genetic assessment in decision making, we can reduce hospitalizations due to side effects and improve the quality of life and reduce postoperative complications for surgical patients.

The other area that I've seen much improvement in is public policy. Our society, SIOG, has been engaged in public policy for a number of years, and we have seen wonderful commitment from multiple stakeholders, including the regulatory action authorities, such as the European Medicines Agency here in Europe or the Food and Drug Administration in the United States, to embed these considerations when it comes to drug regulation. There are also scientific societies and patient advocacy groups increasingly interested and focused on age-attuning cancer care. And, because much of the research in oncology is driven not only by academia but also by pharmaceutical companies, I am seeing increasing interest from them to make the clinical trials and the product much more meaningful for the most frequent end users of novel anticancer treatments: older adults.

What major change would you like to see in the next five years to help close the care gap for older adults with cancer?

A key aspect is to really push now for clinical implementation. We’ve now got years of research and evidence showing numerous benefits of age-attuned care. In France, the National Cancer Plan has been supporting the creation of geriatric oncology units since 2006. Why shouldn't other countries do the same?

I would like to see clinical implementation supported by high-level health care systems. This requires resources to recruit additional personnel in cancer services. And I would like to see more clinical trials being inclusive of older patients with cancer and reporting meaningful endpoints for this population. There should be more relaxed eligibility criteria to recruit older patients and different trial designs to really meet the needs of these patients.

Finally, there’s the national cancer control plans. This is something that SIOG has been working on with some specific countries, such as the Philippines, to really integrate these considerations in national cancer control plans and create funding mechanisms to support and advance the care of older patients with cancer at the national level. It's something that has already been done successfully in some countries, but this is now the time for many other countries to join.

For more information about the topic of cancer and aging, read:
• World Cancer Day campaign.
• Report by the Economist Intelligence Unit supported by Sanofi: Policy responses to meeting the needs of older people.
• When Cancer Grows Old initiative by Sanofi.
• UICC’s thematic webpage.
• Advocacy key points to drive change for older adults with cancer.