Cancer care

Check cancer care ageism at the door: A/Prof. Christopher Steer


Associate Professor Christopher Steer

Ageism is a major barrier to the appropriate care of older adults including those with cancer, according to a leading cancer physician.

It exists at interpersonal and institutional levels, says Associate Professor Christopher Steer, and in a particularly insidious form can also be internalised leading to older adults de-prioritising their own health and delaying presentations to health services from screening through to GP, allied health and specialist care.

Speaking at the COSA ASM 2022, A/Prof Steer said the Human Rights Commission had found that 90% of Australians believe that ageism exists. [link here]

“Ageism affects people across the adult life span, making it the most pervasive form of prejudice and yet the least researched and the most socially acceptable.”

He said a NSW survey [link here] of 140 mostly older people found almost half (48.57%) reported they had been treated differently in healthcare settings because of their age.

The main themes emerging from the survey data were:

  • medical professionals not listening to the concerns of older people
  • minimising and dismissing illness concerns
  • patronising language
  • lack of appropriate care
  • intersectionality of various forms of discrimination

Associate Professor Steer, from Border Medical Oncology and Haematology in Albury Wodonga, said using more appropriate language was one of the easier fixes in addressing ageism in healthcare.

He said terms such as seniors and elderly were inappropriate as were catastrophising references to an ageing population such as “grey tsunami” when it was possible to speak more positively about changing demographics.

“We can be positive, we can change and call out ageist language where it is inappropriate in our MDTs.”

As well, health professionals should not make assumptions based on chronological age alone.

“I have heard often in the MDT, ‘I want to keep this simple on the basis of his/her age’.”

He said ageism could present as less rigorous investigations, lack of discussion of treatment options, assumption of poor tolerance of radical treatment, even assumptions about a patient’s ability to cope if their treatment required travel to a major centre.

“I’m sure that may happen but you can’t assume. You can’t say this patient is 80 years of age, I wouldn’t want to put him through this.”

Frustratingly, the phenomenon of older patients internalising ageism meant they may not advocate for themselves as strongly as they should.

He told the meeting that a scoping review of ageism in cancer care by the International Society of Geriatric Oncology [link here] noted that ageism adds to the challenge of delivering appropriate care to older adults with cancer.

Further work globally had identified the negative impacts of ageism on health to span limits on access to health services and treatment, exclusion from health research, impaired physical and mental health and reduced longevity.

High cost

And the cost of ageism had been estimated at a whopping $63 billion per year in the US as age discrimination, negative age stereotypes and negative self-perceptions of ageing impacted on health outcomes. [link here]

Associate Professor Steer said lung cancer, like many cancers, was predominantly a disease of older adults.

Yet data from the Victorian Lung Cancer Registry [link here] had shown older patients were at higher risk for mortality and receiving reduced cancer treatment as younger patients, matched for comorbidities and performance status.

“This may not be ageist, it may be appropriate, but there is certainly documented less delivery of care in older people,” he said.

Professor Steer told the limbic that no treatment decision should be made on the basis of age alone.

“There is certainly no doubt that over the age of 85, in some models, is a surrogate for frailty but our argument is that an adequate assessment yields appropriate care. Chronological age is just a small part of that.”

He referenced a clinical trial for transplantation in myeloma patients which was open to patients aged 18-65 years.

“If you are 66 you don’t get on the study. It’s completely inappropriate in my opinion. My argument is you do not need that upper age limit. Haematologists can decide on their own.”

“This is the low hanging fruit that we can just abolish. It should not happen.”

He said he was very pleased to hear that the draft Australian Cancer Plan included a focus on older patients.

COSA is hosting a 2-part virtual forum on ageism in cancer care on 22 and 29 November, 2022.

 

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