Challenging landscape for cancer and aging

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

Of all our fears about aging, the greatest may be our fear of losing control.  Cancer care is at a crossroads.  Global cancer incidence is increasing, with more than 35 million new cases expected in 2050, and these increases are coming against a backdrop of health-care systems still scrambling to recover in the aftermath of the COVID-19 pandemic.  Thus, at this crucial time, the future of cancer care faces both challenges and opportunities for reform.

            American Cancer Society reported in early 2024 that with access to cancer care services limited because of COVID-19 control measures, cancer diagnosis and treatment have been delayed.  In the UK, the recent cancer diagnosis of King Charles III has led to renewed attention on cancer care.  During the COVID-19 pandemic, early cancer careening and subsequent referrals were postponed.  Moreover, there were delayed and cancellations for cancer surgeries, radiotherapy, and outpatient appointments.  The crisis in oncology care is not unique to the UK; for example, during the pandemic, national cancer registries from the Netherlands, Slovenia, Denmark, and Belgium reported declines in cancer diagnoses and treatments.

            Despite comprising the majority of patients with cancer, older people face barriers to accessing care.  Limited mobility can make it difficult for older patients, particularly those living in remote areas, to reach hospitals and treatment centers.  Broadly, training and education in geriatric oncology globally remain incommensurate to the aging patient population.  Not only do older people face inequities in cancer care, but the clinical trials informing this care are largely skewed towards younger patient groups with no comorbidities, thus reducing the applicability of trial findings to the many older patients with frailty, multimorbidity, and polypharmacy.

            As we prepare for population aging, we must ensure that older patients are granted ready access care.  A positive outcome of the pandemic was the emergence of telehealth, and these tools should be harnessed to extend the reach of care to older people facing access barriers.  Cancer care must also be tailored to meet the distinct and heterogeneous needs of older patients.  Approaches such as the administration of geriatric assessments, which include measures of comorbidities, physical and cognitive functioning, frailty, and medication use, should be expanded.  Screening geriatric assessments is not only important to increase the likelihood of treatment tolerability in clinical settings, but can also be used in clinical trial recruitment.  In addition to understanding the complexities of treating older patients, practioners must also be flexible in defining treatment efficacy; while extending lifespan might be the desired treatment outcome for a younger patient, an older patient with cancer might instead prioritize maintaining quality of life and independence.  Finally, the continuum of care must extend beyond the acute setting to supporting older cancer survivors.

            Therefore, the personalized and patient-centered approach required for treating older patients with cancer must also be applied to managing cancer survivors.  To prepare for the demographic transition, we must bolster geriatric oncology to support older patients throughout the cancer care continuum.  As we pick up the pieces to restore health care, let us seize this opportunity to reshape cancer care to safeguard the health and welling of our aging populations.