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Friday, July 30, 1999 Published at 01:36 GMT 02:36 UK


Health

Elderly 'denied cancer care'

Routine breast cancer screening has an upper age limit of 65

Elderly people who contract cancer are missing out on potentially life-saving treatment because of discrimination by health staff, say experts.

Over a third of cancers are diagnosed in people over 75.

But many clinical trials have upper age limits, meaning there is little information on how treatment affects older people.

Research shows cancer in elderly people is less likely to be diagnosed and treated than in young people and this is associated with poorer survival rates.

Medical reasons

Professor Peter Selby, clinical research director at the Imperial Cancer Research Fund, says this is partly due to solid medical reasons.

For example, elderly people may be more sensitive to toxic drugs used in chemotherapy and risks associated with surgery increase with age.

But he said non-medical factors also appear to play a part.

Writing in the British Medical Journal, he and colleagues from St James' University Hospital and the Yorkshire Cancer Organisation in Leeds, say there is evidence healthcare staff are less likely to refer elderly patients to specialists.

'Nothing can be done'

They believe this is partly due to ageism, with doctors wrongly assuming nothing can be done, that elderly people do not want treatment or that their lives are not as worthwhile as those of younger patients.

A survey of elderly people's attitudes to invasive procedures found most would want treatment for life-threatening illnesses.

Professor Selby says doctors may underestimate how long an elderly person will live after treatment.

Seventy-five-year old women and men have life expectancies of more than 11 years and more than eight years respectively.


[ image: Over a third of cancers are diagnosed in people over 75]
Over a third of cancers are diagnosed in people over 75
Prof Selby said: "In most cases, if you can live 10 more years with treatment, a doctor would go ahead.

"Doctors in the NHS do have to prioritise cases, but the grounds for this should be explicit and made on carefully thought-out medical grounds."

Biological age

He said there was a tendency in the medical profession to lump all elderly people together, when some older people were clearly fitter than others.

"Good medicine takes into account how fit a person is and their biological age rather than the number of years they have lived," he said.

The researchers also found many elderly people and their families have low expectations of getting treatment.

If they do not push for it, they are less likely to receive it, said Professor Selby.

He believes this may change as new generations with greater expectations of the NHS grow old.

The researchers argue that more research is needed into the treatment of elderly people with cancer, how effective different treatments are and how they should best be managed.

For example, they state that some types of treatment could be modified or dosages lowered so they can be used for elderly people.

'Scrap age limits'

And they say scrapping arbitrary upper age limits for some forms of routine cancer screening, such as breast cancer, could save lives.

Age Concern says many people felt "let down" by the NHS "because they know they are being denied treatment on the basis of their age".

A recent Gallup poll showed one in 20 people over 65 had been denied NHS treatment.

Age Concern wants the government to conduct an audit of age discrimination within the NHS to highlight areas of good and bad practice.



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