The Baby Boomer generation — the fastest growing portion of the U.S. population — is rapidly becoming eligible for Medicare. In fact, 20% of the population will be older than 65 by 2030. But with aging comes an unfortunate increase in cancer diagnosis. Peak cancer incidence rates occur among older adults aged 65-74; (cancer also occurs at a high rate in people older than 75, but they are more likely to die from other medical causes). These seniors face unique obstacles that can complicate their cancer care journey. Read on to understand five potential challenges impacting oncology care for seniors and what organizations may be able to do to try to address them.
1. Comorbidities are more prevalent in senior cancer patients.
Generally, the chance of developing one or more comorbidities increases with age, in part from the prevalence of obesity and poor health behaviors. More than 50% of older adults with cancer have at least one comorbidity that may impact their cancer treatment, such as diabetes, hypertension, heart disease or Alzheimer’s. This will complicate care planning as physicians will have to account for these conditions.
2. Older cancer patients may struggle with declining behavioral health.
By 2030, 7.4% of people aged 65 and older could be medically diagnosed with depression, an increase from 4.2% in 2010. Studies have shown that mental illness like anxiety and depression increases the risk of delaying accurate diagnosis and treatment. More than 40% of older adults with cancer report significant anxiety, though almost half of these patients didn’t receive psychosocial services for it. This increase in behavioral health needs will make care decisions and navigating the care journey more challenging for senior patients or their caregiver – making it essential that oncology programs have a strategy in place to support.
3. Caregiver supply and skillsets don’t meet growing patient needs.
There is a projected shortfall of 3.2 million direct care workers between recent supply and predicted demand in 2026. At the same time, many senior patients rely on “informal caregivers.” These caregivers tend to be older women (i.e., 63-66 years) who are unpaid family members. Overall, three-fourths of caregivers for older adults with cancer reported experiencing some degree of burden, and about 40% have comorbidities themselves. Oncology programs need to consider providing more support for existing caregivers so they can best support patients’ needs in the clinics and at home.
4. Systematic inequities are exacerbated in cancer diagnosis and treatment.
Across studies, racism has been a proven contributor to cancer health disparities. In coming decades, the 65+ racial and ethnic minority population is predicted to increase. Additionally, ageism against older adults in cancer care can be seen in provider bias, reimbursement structures for geriatric care, and exclusion from clinical trials. Oncology programs should consider developing an equity strategy that addresses social determinants of health and their root causes and potential provider bias towards older patients to ensure all patients receive the care they need.
5. Senior cancer patients may experience high financial distress.
Overall, future seniors will have lower overall savings and will be less likely to have pensions and adequate retirement savings compared to previous generations. High financial burden has been connected to lower treatment adherence, shorter survival, poorer prognosis and greater risk of recurrence. Factors associated with level of financial distress include race, employment status and insurance coverage. To help seniors navigate financial costs, oncology programs can prioritize patient education and external assistance.
While these five challenges may not be traditionally “solved,” working toward multi-faceted solutions can help oncology program flexibly and help productively address them for senior patients.
1. Empower and support caregivers of all types.
By assessing caregiver needs, both caregivers and the patients they support will benefit. Better acknowledgement of and engagement with caregivers can help improve their mental health status and technical skillset. Organizations can also actively involve caregivers in telehealth visits and provide community health workers to set up technology required for these visits.
2. Implement multidisciplinary care that emphasizes geriatric assessment.
Expanding the types of care organizations offer can help account for other conditions or ailments that patients have. These may include geriatric care, nutritional care, psychosocial support and palliative care in addition to oncology. With a comprehensive geriatric assessment, the care that older cancer patients receive may be better suited if physicians have a full picture of their health needs.
Advisory Board’s Liam Frieswick, Binqi Chen, and Emily Schmidt contributed to this research.
At Pfizer Oncology, we are committed to advancing medicines wherever we believe we can make a meaningful difference in the lives of people living with cancer. Today, we have an industry-leading portfolio of 24 approved innovative cancer medicines and biosimilars across more than 30 indications, including breast cancer, genitourinary cancer, hematology, and precision medicine.
This report is sponsored by Pfizer, an Advisory Board member organization. Representatives of Pfizer helped select the topics and issues addressed. Advisory Board experts wrote the report, maintained final editorial approval, and conducted the underlying research independently and objectively. Advisory Board does not endorse any company, organization, product or brand mentioned herein.
This article is sponsored by Pfizer. Advisory Board experts wrote the article, conducted the underlying research independently and objectively. Pfizer had the opportunity to review the article.
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