Surgical Tribune Europe

Older cancer patients in the UK miss out on surgery

By Surgical Tribune
December 11, 2014

LONDON, UK: A new report by Cancer Research UK and the National Cancer Intelligence Network has found differences in rates of surgery across 21 different cancer types. Although many factors might prevent patients from undergoing surgery (frailty, suffering from more than one illness, being diagnosed at a late stage and patients choosing against it), these new statistics paint a worrying picture.

According to the report, younger cancer patients were more likely to have surgery for 19 different cancer types, with the largest differences between age groups being 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 number 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) patients over the age of 85 undergoing surgery.

Around 80 per cent of women under the age of 55 underwent surgery for ovarian cancer. This number fell to around 37 per cent of women between the ages of 75 and 84, and then dropped further to only 15 per cent of women over the age of 85.

Surgery for the three main cancer killers—lung, bowel and breast cancer—all follow this pattern of fewer surgeries for older people.

Around 15 per cent of patients under 55 underwent surgery for lung cancer, but less than 1 per cent of patients over 85 underwent the same procedure. For bowel cancer, around two-thirds (64 per cent) of patients under 55 had surgery and this fell to around 39 per cent for over 85-year-olds.

For breast cancer surgery, around three-quarters (76 per cent) of the patients under the age of 55 had surgery, while the number dropped to 24 per cent for those over 85.

Cancer is primarily a disease of old age; therefore, as the population ages, a greater number of cancers need to be treated. This is why more research is vital to uncovering the reasons behind the differences in the number of surgeries and to determine whether older people are provided with the best possible treatment.

Experts believe that surgery is responsible for around half of the cases in which cancer is cured, making it an essential form of treatment. However, surgery is not an option for all cancers. Whether surgery is viable depends 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 possibility of successful treatment. In this way, early diagnosis is key to improving cancer survival.

Dr Mick Peake, clinical lead for the National Cancer Intelligence Network, 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 that 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.”

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