Is Ageism Affecting Patients with Prostate Cancer?

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Older oncology patients are not receiving optimal care because they are being judged by their chronologic age rather than overall level of fitness.
Older oncology patients are not receiving optimal care because they are being judged by their chronologic age rather than overall level of fitness.

New data are suggesting that some elderly oncology patients are being undertreated because of their age. The studies assert that older patients with several different tumor types (including rectal, prostate, and oropharyngeal squamous cell carcinoma) are not receiving optimal care because they are being judged by their chronologic age rather than overall level of fitness.

“I think we do have a problem with ageism in treating some cancers and for prostate cancer in particular due to the perception of universally indolent, or ‘autopsy' disease as men age,” said Judd Moul, MD, the Director of the Duke Prostate Center in Durham, NC.

A recent study found that older oropharyngeal squamous cell carcinoma patients are less likely to receive surgery or radiation therapy (RT) than their younger peers.1

The researchers conducted a retrospective analysis of 14,909 patients with oropharyngeal carcinoma using the Surveillance, Epidemiology, and End Results (SEER) database. All the patients were diagnosed between 2004 and 2009 and the researchers found a significant increase in the number of patients who did not receive treatment (surgery, radiation, or combined therapy) after age 55.

The researchers concluded that, despite the fact that they were not being treated, many patients 55 and older could achieve significant benefits from aggressive treatments regardless of their older age. The researchers suggested clinicians adopt objective measures to assess patient fitness to reduce the potential for undertreatment in the elderly population.

A recent study looking at preoperative radiotherapy for rectal cancer found that older patients are less likely to receive preoperative radiotherapy than younger patients, even though it is the standard of care.2 Researchers looked at 2,619 patients who underwent elective transabdominal surgery for rectal cancer in 2000 to 2010.

The study showed that 1,789 patients (68.3%) received preoperative radiotherapy or chemoradiotherapy and over time the use of preoperative therapy increased. However, in a multivariable model age (80 years or older) and comorbidity (Charlson Comorbidity Index score 2 or greater) were strongly correlated to omittance of preoperative treatment.

RELATED: Elevated C-Reactive Protein Linked with Poor Prognosis in Prostate Cancer

A study published this month suggested that many older men with locally advanced prostate cancer are only receiving androgen deprivation therapy (ADT) alone and not with RT even though RT could significantly improve their overall survival.3

“There is a large gap in care in older patients and it is a real health care concern,” said lead author Justin Bekelman, MD, Assistant Professor of Radiation Oncology, Medical Ethics and Health Policy at The University of Pennsylvania in Philadelphia, PA.

“I don't think it is a bias against radiation, but a bias against treating older patients in their late 60s, 70s, and 80s and prostate cancer is a disease of the aging.”

In an interview with Cancer Therapy Advisor, Dr. Bekelman emphasized the need for communication between clinicians and their patients.“We need to have a discussion on the cure rates, the tolerability of the treatment, and [clinicians and their patients] should come to a shared decision about curative treatments and prostate cancer,” said Dr. Bekelman.

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