As 10,000 baby boomers reach 65 years old each day, the incidence of cancer since 2010 is estimated to increase by 67% by 2030, bringing attention to the nation’s response to cancer care. Cancer is diagnosed at a higher rate, accounts for more survivors, and results in more deaths than in younger patients.
“The increase in the number of older adults, the association of cancer with aging, the workforce shortage, and the financial stressors across the health care system and family networks all contribute to a crisis in cancer care that is most pronounced in the older population,” wrote three members of the Institute of Medicine (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population. Their writing appeared in an editorial published in JAMA, The Journal of the American Medical Association (2013; doi:10.1001/jama.2013.280416).
“Often, caregiving falls to a family member who is also aging,” noted committee member Mary D. Naylor, PhD, FAAN, RN, who is the Marian S. Ware Professor in Gerontology and the Director of the New Courtland Center for Transitions and Health at the University of Pennsylvania in Philadelphia.
As the originator of the Transitional Care Model, Naylor has addressed the unique needs of older adults and their caregivers, offering evidence-based solutions. “We need to address the physical, psychological, financial, and emotional tolls on caregivers by developing more effective ways to prepare and support them.”
The authors noted potential improvements to cancer care among older persons, including:
• Passing new laws extending the time period for clinical trials (similar to laws passed for pediatric patients) in order to include more older adults, noting that, “although the majority of patients with cancer and cancer survivors are older adults, historically they have been and continue to be underrepresented in all types of cancer trials. The result may be that drugs are tested on a younger and fitter population that belies potential health risks to older people who may also have more than one condition;
• Letting the patients decide what works. The authors recommended “publicly reported, robust measures of patient-reported outcomes meaningful for this population;” and
• Establishing a national workforce commission “to plan for the challenges of an aging population and the complexity of care required by older adults with cancer, including a workforce that values multidisciplinary teams and geriatrics principles.”
The IOM committee published a report in September 2013, titled, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. They concluded that the cancer care delivery system is in crisis because of a growing demand for cancer care, the increasing complexity of treatment, a shrinking workforce, and rising costs.