A round table addressing the issue of ageism in oncology was convened at this year's EHA meeting in Barcelona. The panel, which included Mario Bocardoro, Reinhardt Stauder, Pierre Fenaux and Richard Sullivan, and chaired by Gordon McVie from ecancer, discussed the issue of age discrimination when treating patients with cancer, with a particular focus on haematological cancers.

From an epidemiological point of view, the elderly population are going to dominate healthcare in the near future. By 2025, it is estimated that around 30% of the population will be over the age of 65 years. Yet, healthcare of the elderly remains a low priority for European governments. This increase in the elderly population has important economic and social implications for healthcare provision and, with over 50% of newly diagnosed cancers occurring in the over 65s, for cancer care. However, many clinicians are unsure how best to manage this patient population.

Ageism is still occurring in clinical oncology

From a review of the published literature and opinions and perceptions within clinical practice, there is clear evidence that older patients with haematological cancers are undertreated, frequently being offered suboptimal therapy or best supportive care, and are frequently excluded from clinical trials.

Survival rates have dramatically increased with the development of newer, more effective therapies, yet this has not translated to elderly patients even though the therapeutic efficacy is independent of age. This has been seen in patients with multiple myeloma, myelodysplastic syndromes and chronic myeloid leukaemia. Analysis in patients with multiple myeloma demonstrates evidence of improved survival in younger but not in older patients, largely as a result of under-treatment. Additionally, prescription data in patients with chronic myeloid leukaemia indicate that 50% fewer patients between 71-80 years of age are getting gold standard therapy versus patients less than 40 years of age.

When it comes to clinical trial inclusion, the average age of patients is around 10 years younger than that seen in the haematological cancer population and patients are often not representative of that seen in clinical practice.

Elderly patients with cancer are receiving suboptimal healthcare

This heterogeneity in the provision of oncology care in the elderly and their under-representation in clinical trials is largely fuelled by the misperception that older patients are too frail or unwilling to undergo active treatment.

It is recognised that the treatment of elderly patients with cancer brings its own challenges. It requires the buy in of policy makers, the development of appropriate guidelines and the involvement of the entire multidisciplinary team managing these patients.

One key factor to take into consideration when deciding how best to treat elderly patients with cancer, is the biological and not chronological age of the patient.

Biological and not chronological age should be considered when making decisions on cancer care

Appropriate screening tools are needed to do this and will need to include assessment of comorbidities, as well as functional, nutritional, cognitive social and biochemical factors. Geriatricians will have a particularly important role when it comes to developing appropriate assessment scales.

Many of the newer, less toxic agents available offer the opportunity to treat all categories of elderly patients with haematological cancer. This reduced toxicity combined with the ability to administered at home, will result in reduced hospitalisation costs and will improve patient willingness to take medicines, so improving outcomes.

The are many important goals for the future management of older patients with cancer, including better education of both the clinical community and their patients, the development of policies and guidelines to guide care, and the communication within multidisciplinary teams to develop appropriate assessment tools to tailor treatment to individual patients.

With the ever increasing elderly population, who make up the majority of patients seen with cancer, there is now an urgent need to rethink cancer care in this population.