Hat tip to Catherine Foot and the King’s Fund
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As usual, I was listening to the Today programme, on Radio Four this morning and Catherine was on. Catherine Foot works at the King's Fund. James Naughtie was interviewing her and for the first time I can recall, there was a major cancer story that actually mentions older people with cancer.
Good Lord! Is this a watershed moment? I hope so.
Excellent. The wonderful Catherine was talking about her work, along with co-author Tony Harrison entitled ‘How to improve cancer survival: Explaining England’s relatively poor rates’ published today by the King’s Fund and Cancer Research UK.
England’s poor survival with cancer comes down to inequalities, treatment variation and co-morbidity, particularly in older people. They keep coming back to what is, or, rather, isn’t happening to older people with cancer in England; less aggressive treatment when more aggressive treatment is quite likely to be effective rather than burdensome; late presentation; and poorer survival one year post operatively than in other countries etc. etc. Read the report. It’s all very clear.
I’ve been interested in old age and cancer for several years. As previously bleated about in this blog (but with considerably less academic rigour than Catherine and a lot more grump) there needs to be more work in many areas, such as the Cancer Awareness Measure, to assess the state of cancer awareness in older people.
They are the archetype cancer patients and we avert our eyes, we keep averting our eyes - to women, mostly and younger people too. And then there’s NAEDI – the National Awareness and Early Detection Initiative, which surely needs some thrust particular to the needs of the elderly? The majority of elderly men and women are juggling the symptomatology of any number of more or less serious co-morbidities. Double that for all the men and women with dependent partners, then there’s all the infelicitously named 'geriatric syndromes' to add to the mix - all combining to make matters more complicated than just a list of symptoms to recall.
It’ll take a mighty effort of will to get it to work. I hope there is one. The single issue cancer charities won’t step up to mark any time soon, preferring passive aggressive turf wars, disingenuously lumping awareness raising for cancer - a health promotion activity - with brand recognition of their corporate ID - to support their business objectives.
Combined, they may have some resource to mould an older persons’ (I’m meaning 75+) Awareness Initiative. Mind you, I doubt there’s any mature or current evidence base from the single issue cancer charities that show what it could contain, or how best to do it.
Individually, the single issue cancer charities certainly do not have the resource to create such a thing. I remain sceptical of what the single issue cancer charities bring to this issue that might actually suit elderly people. Which, as cancer is largely a disease of ageing, is deeply disturbing.
Please show me I’m wrong. I’ll be so pleased!
I have written extensively and more, sometimes less, rabidly about this elsewhere on this blog. Here's a little list but not an exhaustive one. Blunder about on the blog and you'll find more.
- Pretty much any post from November 2010 - I seem to have been particularly narked there, on cancer awareness and also on ageing, sometimes at the same time. See menu on the left.
- And again - August 2010 and it was all about older men and prostate cancer with some grumps apbut the Vision for prostate cancer - a policy initiative at the time, connected with pushing the Cancer Reform Strategy on, but frankly cockeyed on the significance of age and the voluntary sector not taking any lead on it.
- Then there's Breakthrough Breast Cancer and the ‘Every Chance’ campaign, on age equality - and I have a go at them for being silly. Or worse.
- And then there’s the generic disregard in which we hold our older people. Even if we ever get cancer services sorted out we’re still capable of inflicting vagaries of the rest of the NHS on them. As mentioned here - 'The 'don't really care' of elderly people on the NHS'.
- To that cheery summation on the last bullet point, I add the recent story about the CQC (Care Quality Commission) raising concerns about the care of the elderly in three NHS Trusts. You must remember that? The story included the news about medics prescribing water in a vain attempt to deliver care to elderly people in hospital in Redditch.
Anyway. Moving on - I quote from Catherine’s conclusions:
“Management of cancer in older people (Page 20)
Researchers, policy-makers, commissioners, providers and patient groups will want to understand urgently the worse survival of older people in England, and what can be done about it. Evidence suggesting age bias in access to treatment should be investigated as a priority. The particular experience and needs of older people will need to be considered in any initiatives aiming to improve earlier stage diagnosis or access to treatment.”
I have no issue with anything Catherine and Tony wrote. Indeed, I hope it’s clear I really applaud it. Except I do have an issue with a verb in the first sentence…... Researchers, policy-makers, commissioners, providers and patient groups “will want to understand.....”.
I suggest the verb is the wrong one. ‘Will want’ is totally over-estimating the drive for change. ‘Should’ is as close as we can get. We all need ‘researchers, policy-makers, commissioners, providers and patient groups’ to understand what the hell is going on with old people with cancer. I’d like them to ‘want’, but until public opinion realises that older faces are also their faces, cancer with an older face won't ever fit into the media, or get higher up the agenda of health concerns generally.
At best, public opinion is ambivalent about older age. At worst it's much worse than that.
That’s not media driven. It’s possibly media maintained, but its origins are with us, not Fleet Street, the BBC or Sky. The media is merely reflecting our shabby selves back to us. Ambivalance about old age is an unspoken truth in our wider society, like racism and sexism used to be. At least we can expect those two to be consistently challenged, not that there aren't still far too many racists and sexists in existence. Old ageism doesn't yet share the status as an 'ism' that diminishes us all.
Society has to get over its collective failure of imagination about who it is that is older. Any of us could be the one in three who might get cancer, or the one in four who will die from it - most probably at an older age. Old people are not ‘other’, ‘alien’, ‘your worst nightmare’. They are simply us, but older.
Press for them to be treated as you would yourself want to be treated. As Catherine and Tony show, your survival depends on it.
