Enrique Soto-Perez-de-Celis1 and Eduardo Cazap2
1Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Vasco de Quiroga 15, Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
2Editor in Chief, ecancer, 13 King Square Avenue, Bristol, BS2 8HU, UK and President, Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
Corresponding author: Enrique Soto-Perez-de-Celis Email: enrique.sotop@incmnsz.mx
The progress achieved during the last century in the fields of public health, sanitation, agriculture, and technology has led to an unprecedented and continuous increase in the life expectancy of individuals worldwide. This, in turn, has led to an increase in the number of older individuals (aged 65 years and older) globally, with most of this growth taking place in low- and-middle-income countries (LMICs) [1]. Currently, of the almost 760 million people aged ≥ 65 years globally, almost 70% (521 million) live in LMICs [2]. By 2050, the estimated number of people aged ≥ 65 years will be almost 1.5 billion, global life expectancy at birth will surpass 74 years, and 15% of people living in LMICs will be older than 65 years [1, 3]. The growth in the number of older adults in LMICs will bring along an increase in the incidence of cancer, which is a disease strongly associated with aging [3]. According to GLOBOCAN, of the 10 million cancer cases diagnosed worldwide among people aged ≥ 65 years in the year 2020, 49% occurred in LMICs, and this proportion will continue to increase over time [4]. As with every aspect of cancer care, disparities are evident across income levels, with the incidence-to-mortality ratio for all cancers among older adults being higher in LMICs [4].
In such an aging world, there is an incredible need for all stakeholders in LMICs, including patients, caregivers, clinicians, and policymakers, to join to increase the geriatric competencies of the workforce and the capabilities of healthcare systems to provide care for older patients. Geriatric Oncology, which refers to the multidisciplinary care of older adults with cancer, is not a luxury for developing countries, but rather a necessity, and the oncology community needs to make this one of its priorities. This Special Issue, dedicated to Geriatric Oncology in resource limited settings, includes essential data regarding global cancer and aging, and highlights various initiatives aimed at providing high-quality care for older adults with cancer worldwide.
In the first article [5], Dr Sophie Pilleron and colleagues use GLOBOCAN data to provide a detailed description of cancer incidence among people aged 60 years and older in LMICs, including projections regarding the future number of cases by World Bank income level. An extremely interesting finding from this study is that cancer cases in older individuals will almost double over the next 20 years, with most of this increase occurring in lower-middle-income countries. In contrast with literature from high-income countries, this study considers persons aged 60 years and older, which fits the definition of older adults in many developing regions of the world. An essential step towards solving a problem is understanding and measuring it, and the results of this study provide very compelling data supporting the need for investing in age-friendly healthcare systems in developing regions of the world.
Two articles in this Special Issue, led by Dr Vanita Noronha from India [6] and Dr Theodora Karnakis from Brazil [7], report on the implementation and development of Geriatric Oncology programmes in two large public institutions located in two of the largest emerging economies of the world. While there is a significant amount of information regarding the creation and implementation of such programmes in high-income countries in Western Europe and North America, there is a lack of guidance on how to develop them in LMICs. Understanding the best strategies, as well as the barriers that need to be overcome to successfully develop such a programme, is essential for establishing centres of excellence in Geriatric Oncology in developing regions of the world, which is one of the top priorities set forth by the International Society of Geriatric Oncology (SIOG) [8].
While creating centres of excellence is certainly a priority, there is a need to increase the geriatric competencies of the entire workforce, since a large proportion care for older adults with cancer and older cancer survivors will be provided by oncologists and general practitioners, and not by geriatric oncologists and geriatricians. Although initiatives like the ones reported by Drs. Noronha and Karnakis are extremely important, both were implemented in large hospitals in metropolitan areas, which may not be representative of the situation in smaller cities in LMICs. To increase the reach of Geriatric Oncology, there is a need to increase the competency of the entire workforce by providing training for both geriatricians and oncologists and by fostering the development of multidisciplinary teams in smaller hospitals and cancer centers.
The fourth article in this Special Issue [9], by Dr Haydeé Verduzco, explores the confidence with the evaluation of specific geriatric assessment domains among oncologists in Mexico. In this study, self-perceived confidence with evaluating various domains was related with a higher likelihood of reporting that those domains were usually evaluated in clinical practice. However, when asked about the types of evaluations performed, the researchers discovered that most were not conducted according to guideline recommendations, highlighting the need for improved education on how to perform a geriatric assessment. Studies like this one, assessing the gaps in Geriatric Oncology in LMICs, are an important stepping stone for developing future initiatives aimed at improving knowledge and fostering access to care to a broader population.
The increasing number of older adults with cancer is a global challenge, and healthcare systems in LMICs need to act now. Research like the studies presented in this Special Issue provides important information regarding the magnitude of the problem, existing successful models for implementing Geriatric Oncology in resource limited settings, and ways to move forward to increase the reach of such models. Only through collaboration and through dissemination of research on global cancer and aging, will we be able to provide high quality care for older adults worldwide, regardless of where they live.
References
[1] United Nations, Department of Economic and Social Affairs, Population Division (2020) World Population Ageing 2019 (ST/ESA/SER.A/444)
[2] The World Bank. Data Bank. Population ages 65 and above, total. https://data.worldbank.org/indicator/SP.POP.65UP.TO?view=chart. Accessed online April 12, 2023
[3] Soto-Perez-de-Celis E, de Glas NA, Hsu T, Kanesvaran R, Steer C, Navarrete-Reyes AP et al (2017) Global geriatric oncology: Achievements and challenges J Geriatr Oncol. 8 (5) 374-86
[4] Bray F, Colombet M, Mery L, Piñeros M, Znaor A, Zanetti R, Ferlay J, editors (2021) Cancer Incidence in Five Continents, Vol. XI IARC Scientific Publication No. 166 (Lyon, France: International Agency for Research on Cancer) Available from: https://publications.iarc.fr/597. Licence: CC BY-NC-ND 3.0 IGO
[5] Pilleron S , Gnangnon F, Noronha V and Soto-Perez-de-Celis E (2023) Cancer incidence estimates in adults aged 60 years and older living in low-and-middle-income countries for the years 2020 and 2040 ecancer 17 1594
[6] Noronha V et al (2023) The current status of geriatric oncology in India ecancer 17 1595
[7] Karnakis T et al (2023) Ten years of a geriatric oncology service at a public university cancer centre
in Brazil ecancer 17 1596
[8] Extermann M, Brain E, Canin B, Cherian MN, Cheung KL, de Glas N et al (2021) Priorities for the global advancement of care for older adults with cancer: an update of the International Society of Geriatric Oncology Priorities Initiative Lancet Oncol. 22 (1) E29-E36
[9] Verduzco-Aguirre HC (2023) Factors associated with the evaluation of geriatric assessment (GA) domains by oncology specialists in Mexico ecancer 17 1597
