Growth in number of older adults with cancer requires new approaches
As the number of older Americans skyrockets, cancer advocates must join the conversation
By 2060, the number of older adults in the U.S. is expected to double, with Black and LatinX populations tripling. Older people with cancer face the challenges of aging in the context of racial and ethnic disparities.
Looking through a health equity lens
In her talk “Why Older Adults with Cancer Belong,” Sherrie F. Wallington, PhD, of George Washington University called for health equity for older adults with cancer. Inspired by her grandmother, a two-time breast cancer survivor who lived to be over 100, Dr. Wallington emphasized intentionality. She said viewing cancer care through an equity lens can be achieved by asking questions like:
- Who are the specific groups affected by a policy, practice, program, or decision? What is the potential impact on them?
- In what ways does a particular policy, practice, program, or decision ignore or worsen health disparities? What other implications need to be considered?
- How have we involved the people affected by this policy, practice, program, or decision?
Bring patients into the process through outreach, conversations, or whatever strategies work, Dr. Wallington said. She acknowledged that this can be difficult. People with cancer are already managing the psychosocial, practical, and physical challenges of treatment. Yet engagement improves treatment delivery and outcomes. And doctors often lack the skills to engage older adults who face discrimination and biases. For example, they don’t use plain language to talk about health.
Older adults are less likely to be offered or to join clinical trials. Dr. Wallington attributed this to ageism, biases, and barriers in clinical trials design. Geriatric assessment tools are useful to gain honest information about older adults’ needs and capabilities in health care, and to eliminate the possibility of treatment plans based on assumptions or preconceived ideas. These tools, which doctors often use when they suspect a problem, help to evaluate an older person’s ability to function in day-to-day life; their physical and mental health; their thinking; and the social and emotional supports they have around them.
Barriers to cancer care
Melody K. Schiaffino, PhD, MPH, of San Diego State University School of Public Health studies health care delivery in diverse, vulnerable older adults, many of whom have limited English language skills. Among the many barriers Dr. Schiaffino reports among the people she serves:
Doctors make assumptions about older adults’ insurance, ability to pay, or documentation. As a result, they may over- or under-treat older people or limit their treatment options, giving an illusion of choice, Dr. Schiaffino said.
Biomarkers in older adults
Nikesha J. Gilmore, PhD, of the University of Rochester, discussed a role for biomarkers in treating older adults. Lifetime experiences can affect our biology. It increasingly will be possible to learn about a person’s psychosocial health and stressors by looking at their cells under a microscope. This information could be taken into account when choosing treatments.
In Dr. Gilmore’s words, “As we make progress toward equitable approaches to research and healthcare in oncology, biomarkers in conjunction with determinants of health care provide insights into health disparities and the development of equitable interventions to improve the care and outcomes of older adults with cancer.”
How breast cancer advocates can help
The session concluded with calls for action, led by John Simmons, MD, of Kaiser Permanente Medical Center, a doctor, patient, caregiver, and advocate who talked about the value of a the Cancer Aging and Research Group, or CARG. This group, which was started by the late Arti Hurria, MD, joins geriatric cancer researchers and all who support them to collaborate on clinical trials that improve care for older adults. As people with cancer age, so do their caregivers. Cancer providers can better address the needs of older people with cancer and their caregivers through the resources available at CARG. Dr. Simmons also encouraged screening widely for psychosocial issues.
Other ways breast cancer and other cancer advocates can help were detailed by Dr. Wallington and echoed by the other presenters:
- Define health disparities and health equity, and be inclusive of differences by age and within age groups
- Collect sociodemographic data, including age
- Advocate for addressing disparities among age groups across socioeconomic groups
- Implement age-friendly health systems and measure disparities between age groups
- Use a team care approach for older adults
- Train more people in geriatric health and geriatric oncology
- Apply a health equity lens to cancer research and practice, especially in clinical trials
- Help educate and prepare older adults to advocate for health equity