….Talking ‘bout my generation.... THEY won’t talk about ageing….

There are three things to keep in the back of your mind when reading this. They are a) over one third of new cancer diagnoses are in men and women who are aged 75 years and older b) over half of all cancer related deaths are in men and women who are aged 75 years and older and c) recent scandals involving death or neglect in the NHS have been almost exclusively concerned with failings in the care of older people.

 
The Department of Health and the NHS have been battling with cancer care for many years. The Cancer Reform Strategy is the child of the Cancer Plan, continuing progress since 2000 when the initial Cancer Plan was devised. It was meant to improve cancer outcomes in the UK which lagged (they still do, but not so much) behind Europe. The Strategy identifies older men and women, along with some other groups e.g. people from black and minority ethnic communities as at risk of experiencing inequality in provision of, and access to, cancer services.
 
As a step along the way to implementing the Cancer Reform Strategy the National Cancer Survivorship Initiative Vision has just been launched (January 2010). This document ‘describes the emerging vision for improved care and support for people living with and beyond cancer.’  
 
The broad sweep of the ambition in this document is commendable. The concept of cancer survivorship is a story in itself. Many aspects of it e.g. seamless care, a proposed study of social care utilisation and co-ordination of care will mean that anyone with cancer will undoubtedly benefit.
 
However, there is a remarkable lack of references to older people in the document. Revise points 1 and 2 above. Needs based service delivery is, of course, a more appropriate ambition than age based, but take that too far and you'll not recognise the bad effects of increasing age on the likelihood of those needs being met. There has to be a level of suspicion about the likelihood of frailty, cognitive impairment, co-morbidities and the impairments of ageing rearing up to muddle cancer service delivery in this age group.
 
The photographs in the Vision document do include a good range of obviously older people, but that is it. None of the written references to age relate to older people, which is odd since cancer is mostly a disease of ageing. The case studies featured, or mentioned in passing, are 31, 49, 55, 57, 57 and 59 years old respectively. There are no references to ‘over 75’, ‘aged’, ‘older’ or ‘elderly’. The only uses of the word ‘old’ come in phrases such as Patient X ‘55 yrs old, said…’ There is one reference to ‘over 65’, in order to note 63% of new cases of cancer are in that age group.
 
However, there are 48 references to ‘young’. Part of that is because there is a specific work stream related to cancer care in youngsters but the imbalance is still a puzzle. Is this absence of older people merely an oversight, or has the general societal invisibility of older people permeated the Department of Health? The cancer charities may have been unable to provide examples for case studies and so they should be challenged vigourously on that, too…..
 
Older people with cancer are invisible. When did you last see anyone with cancer over the age of 75 the subject of any news headline, a case study in the press, a cancer charity’s campaigning position or awareness raising effort or research breakthrough? The only time you are certain to see newspaper references to older men and women with cancer is in the obituary columns and death notices.
 
If you are 75 or older, or your Mum or Dad is, what message do you get about  cancer in this age group? Now, just quickly, revisit the first paragraph. It’s not positive, is it? I fear the quality of cancer survivorship is seen as a right for the young but a privilege for the old. 
 
This total invisibility of old people has contributed to delays in identifying and solving systemic problems in cancer care and this document was a missed chance to address some of that.
 
I hope I die before I get old. My generation wrote the Cancer Survivorship Vision, for heaven's sake. If they can't see older people now they'll be invisible themselves in twenty or twenty five years' time.