Ageism in cancer care
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1614 (Published 28 February 2014) Cite this as: BMJ 2014;348:g1614
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Lawler et al. signal a very relevant and timely topic, i.e., the seeming inequality in cancer treatment administered to elderly as compared to younger individuals with similarly advanced disease. [1] Also, they note several relevant issues such as the demographic transition and the lack of evidence for ‘ageism’ solely based on calendar age, or in fact properly designed clinical studies to either corroborate or challenge the present practice across many countries. However, fundamental issues that should be part of the equation of clinical decision making are not really alluded to.
First and foremost is the fact that with increasing age co-morbid conditions become rule rather than the exception. These may very well determine the prognosis and overall survival. Thus deciding on treating or not, and if, how to treat is not straightforward. One should first decide on what outcome to optimize. Is this going to be disease free survival or should an outcome less alien to individuals such as functioning and well-being be considered. Without first addressing this challenging yet prominent ‘geriatric’ question the entire discussion looses solid ground as no one can judge whether the current practice variation reflects a ‘common sense’ of optimizing quality survival time or indeed under-treatment. Importantly, should one decide to take the shortcut and simply treat regardless of age and co-morbidity, overtreatment, squander and transgressing the ‘primum non nocere’ might be the result.
Next, more or less related is the issue of optimizing the return on investment of scarce resources. All over the world, and particularly in the Western part that is in the privileged position to even be able to consider prescribing increasingly costly personalized cancer treatment, one recognizes the fact that the costs of health care are rising at a pace surpassing that of the GDP by at least two-fold, and therefore non-sustainable. [2] Clearly without simply pleading for crude and simplistic budget cuts, scarce public resources have to be consumed such that the balance between costs and effects reflect our equitable societal values.
The demographic transition makes these issues, which a propos are by no means limited to cancer care alone, all the more pressing. The challenge Lawler et al. began to touch upon is broader still and goes beyond a “geriacentric” strategy, to the full scope of an ageing society.
References:
1 Lawler M, Selby P, Aapro MS, Duffy S. Ageism in cancer care. BMJ 2014;348:g1614
2 Health: spending continues to outpace economic growth in most OECD countries. http://www.oecd.org/newsroom/healthspendingcontinuestooutpaceeconomicgro...
Competing interests: No competing interests
Re: Ageism in cancer care
The nineteenth century was changed by a series of events. Many milestones were proved in the development of medical science and information technology sector. Globalization and socioeconomic changes not only resulted as a boon to human society but brought drastic changes in the environment1. Various surveys conducted in a number of countries indicate that 9 out of every 10 people suffer from at least one aspect of minor to major ailments from a simple cold to cancer over a period of 30 days.
Cancer is the one which is still mysterious to the medical fraternity. Cancer is a biologic puzzle. And the term cancer refers to more than 100 manifestations in the biological, chemical and genetic structure of the cell. There are a number of hypotheses, but still there is no unanimous agreement on the cause that states how normal cells grow abnormally and result in cancer. But there could be many different good reasons based on valid ways to treat cancer.
Studies reveal that the high cost of anticancer drugs has created serious problems with Geriatric care in the United States. As per The American Cancer Society study, the cost of cancer care in the US rose by 25% between 2004 and 2007, mainly because of the increased cost of anticancer medicines2.
In the present era every medical professional is aware that Medicine is not just a science—it is a humanitarian activity3
As we know, the art of medicine was born with the birth of the first man. This is the right time to think not only about diagnostic skill and medicines but the cost to treat cancer in older people. Medical community also thinks about alternatives like Dries cancer diet, which mainly suggests the consumption of raw fruits. We also throw eyes on 'free radicals' which play an active role in etiopathogenesis of cancer and the use of antioxidants and vitamin rich diet.
According to Prof Hegde BM, Former Vice Chancellor, Manipal University, Manipal, India, treatment for “cancer is care, not cure”. This supports the view that palliative care is the symptomatic management only, while psychosocial and spiritual support for patient and family play a vital role.
Complementary and alternative therapies like Chinese medicine, Ayurveda, yoga, etc. are considered viable treatments for benign and malignant tumors. But the main problem of CAMs is lack of scientific data, every system of CAM has its own principle, philosophy and preoccupied thought like they are free from side efffets5, Herb- drug, Food- drug interactions 6, etc.
Stem cell research and regenerative medicines are rays of hope in cancer research. Finally, it is better for me to conclude with William Osler's famous saying “The greater the ignorance the greater the dogmatism”.
Reference:
1. Osoba D. Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol. 1994:12:608-616.
2. News feature: Costly US anticancer drugs pose problems for doctors and patients BMJ 2008;337: a778
3. Editorial: “Why do doctors use treatments that do not work?” BMJ 2004; 328: 474-475
4. The SU.VI.MAX Study: A Randomized, Placebo-Controlled Trial of the Health Effects of Antioxidant Vitamins and Minerals on health. Arch Intern MED. 2004 Nov 22;164 (21): 2335-2342
5. Piscitelli SC Drug interactions in patients infected with human immunodeficiency virus, Clin. Infect Dis 1996;23:685-693
6. Engelbrecht AC, Shargel L. Drug –Drug and Drug-Nutrients. Editors. Comprehensive Pharmacy review 2005th ed Philadelphia. Lippincott Williams and Wilkins; 2004,384-392
Competing interests: No competing interests