By Dany Habr, M.D., Chief Medical Officer, Pfizer Oncology
COVID-19 is exposing issues in the way we treat older people living with cancer, particularly people of color.
While we all want to assert that age is “just a number,” when it comes to receiving optimal care — whether for COVID-19 or other diseases such as cancer, where my passion is and my work is focused — we are all too often beholden to that number.
The disproportionate rate of COVID-19 fatalities among adults over the age of 65 has brought to light, in dramatic and tragic ways, the inequities in treatment for this subpopulation.[1] One example is the tragic loss of life in nursing homes, which as of the beginning of June, accounted for nearly half of all COVID-19 deaths.[2] It’s time we ask ourselves the hard questions about the unintended marginalization of older people – specifically people who have been historically disadvantaged because of racism and its related systematic under-investments – within our communities and our healthcare system.
Because the truth is we are living longer, healthier and more active lives. In 2019, 24% of men and 16% of women ages 65 years or older in the United States were employed.[3] According to an AARP analysis, 32% of people in this age group volunteer on a weekly basis and generally allocate more hours to volunteering than do younger groups.[4] Our country’s older population isn’t just surviving, they’re thriving.
So why are our mothers, fathers, aunts, uncles and friends, 65 and older, not receiving the best care we can offer – particularly when it comes to cancer? They make up 54% of cancer diagnoses, and unfortunately 70% of cancer-related deaths.[5] It’s a complicated problem that spans challenges in our medical, societal and policy arenas.
First, healthcare professionals have limited clinical trial data on which to base their recommendations for treatment. Despite comprising the majority of people living with cancer, only approximately 40% of enrollees in registration trials of new cancer therapies were from this age group.[6] Second, we see different treatment decisions by age across multiple cancer types including colon, prostate, breast, lung and some blood cancers. For example, one study of older patients with stage III non-small cell lung cancer revealed that approximately 62.7% of patients aged 80 years and older received no cancer-directed care, which was associated with a lower overall survival compared to those receiving treatment.[7] Another study reported that increasing age was found to be a contributing factor in the approximately 25% of adults with acute myeloid leukemia who did not receive chemotherapy.[8] And while tools to support these important decisions are available, such as a geriatric assessment, they are not routinely used or applied by healthcare professionals.[9]
There are also policy and societal gaps that contribute to this systemic problem. Unintended distortions in policy, such as zero ceilings on Medicare co-pays and limited coverage to address social determinants of health, including transit to and from appointments, have led older people to frustrating roadblocks to adequate care. A 2018 study found older people living with cancer had high levels of unmet medical and informational support needs, from how to recognize and address health issues to understanding physician recommendations.[10] These issues related to age are only further exacerbated by racial, socioeconomic and geographic barriers to care. For older Black people, for example, the data show that they are more likely to die of cancer than older white people in the United States.[11],[12] At a time when racism is at the center of our national conversation, change must come, biases must end, and we must strive for the highest quality outcomes for all Americans regardless of race, and regardless of age.
Cancer doesn’t discriminate, and neither should cancer care. That’s why Pfizer is working with the cancer community to tackle these issues and identify solutions. The U.S. Food and Drug Administration and the American Society of Clinical Oncology have recognized the limited data to guide treatment decisions for older people as a significant problem and issued recommendations to improve the evidence base for treating older people living with cancer in clinical trials. In conjunction with the Association of Community Cancer Centers (ACCC), we are supporting a self-assessment tool for healthcare professionals to identify areas for improvement in the care of older populations. And with the Academy of Oncology Nurse & Patient Navigators (AONN+), we are creating a Navigator Module to educate oncology nurse navigators and patient navigators on how to support the needs of older people living with cancer, including a focus on people of color. We’ve also partnered with the American Cancer Society to award medical grants to help reduce disparities between Blacks and whites with breast and prostate cancers.
But more needs to be done to address the systemic shortcomings that impact cancer care as we age. COVID-19 has exposed ageism and structural inequality within our society and healthcare system. The time is now to work together to tackle this complicated issue on all fronts.
We can do better for our families, our friends, and our own futures.
Explore Pfizer.com to learn more.
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