Older cancer patients missing out on surgery

Cancer Research UK

Older people are less likely to have cancer surgery compared to younger people according to new data* published today (Friday).

"We need to understand what is driving this difference. Earlier diagnosis is incredibly important and something we’re pushing for as it will mean more patients will be suitable for surgery and other treatments. But if older patients are not being offered a surgical option, that is wrong." - Nick Ormiston-Smith, Cancer Research UK

The new report by Cancer Research UK and the National Cancer Intelligence Network reveals the difference in rates of surgery across 21 different cancer types. While many factors might be at play - frailty, suffering more than one illness, being diagnosed at a late stage, patients choosing not to undergo surgery – these statistics paint a worrying picture.

Younger cancer patients were more likely to have surgery for 19 cancer types, with the largest differences between age groups seen in kidney and ovarian cancers.

Surgery was performed on almost three quarters (73 per cent) of all kidney cancer patients aged between 15 and 54. This halved to a third (36 per cent) of patients aged between 75 and 84, and fell even more dramatically to only one in ten (11 per cent) of patients over 85 having surgery.

Around 80 per cent of women under 55 had surgery for ovarian cancer. This fell to around 37 per cent of women between 75 and 84, and then to 15 per cent of women over 85.

Surgery for the three biggest cancer killers – lung, bowel and breast – all follow this pattern of less surgery in older people.

Surgery for lung cancer was given to around 15 per cent of under 55s but less than one per cent of those over 85. For bowel cancer, around two thirds (64 per cent) of under 55s had surgery and this fell to around 39 per cent in the over 85 year olds.

And for breast cancer patients, around three quarters (76 per cent) of those under 55 had surgery and this dropped to 24 per cent for those over 85.

Cancer is primarily a disease of old age and so as the population ages, a greater number of cancers will need to be treated. This is why more research is vital to uncover the reasons behind the differences and to determine if older people are provided with the best treatment for them.

Experts believe that surgery is responsible for around half of the cases where cancer is cured, making it an important form of cancer treatment.

Surgery is not an option for all cancers. It can depend on where the cancer is located, and importantly, at what stage the cancer is diagnosed. The earlier a cancer is detected, the less likely it is to have spread and the greater the chance for successful treatment. Early diagnosis is key to improving cancer survival.

Dr Mick Peake, clinical lead for the National Cancer Intelligence Network (NCIN), said: “Surgeons take into account a number of factors when deciding whether to offer surgery to older cancer patients, such as whether the individual has other illnesses and the patient’s own personal choice. However, surgery is an effective treatment for many types of cancer and we need to ensure that patients are assessed on their individual fitness to undergo treatments irrespective of their age."

Nick Ormiston-Smith, Cancer Research UK’s head of statistics, said: “These figures provide further detail about the age bias that older cancer patients face. Previous research has suggested that some older patients who are eligible for surgery may be overlooked because of their age.

"We need to understand what is driving this difference. Earlier diagnosis is incredibly important and something we’re pushing for as it will mean more patients will be suitable for surgery and other treatments. But if older patients are not being offered a surgical option, that is wrong.

"Surgery is an incredibly important part of a cancer patient’s treatment. If it’s suitable, surgery is often a key part of why many people survive a cancer diagnosis. It may not always be an option if cancer has been diagnosed late and has spread or if they aren’t well enough for the operation. Also, a patient may decide they don’t want to undergo surgery.  But it’s vital we remove any barriers so that patients who might benefit from surgery are offered it. We clearly need more research to better understand the reasons why some older people may be missing out."

ENDS

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Notes to Editor

* Major resections by cancer site, in England; 2006-2010.

The report reviewed cases from 2006 to 2010 for people aged over 15 in England.