Age 'should not be barrier to treatment'
Decisions around whether to offer a person surgical treatment should not be based on age and fitness, according to a new report.
The UK has an ageing population, with the number of people aged 75 or over set to almost double in the next 25 years.
A result of this is that the number of people with age-related illness such as cancer, heart disease and arthritis is expected to rise.
However, a report by the Royal College of Surgeons (RCS), Age UK and MHP Health Mandate, has found that the likelihood of surgical treatment being offered for these conditions declines steadily with age for those over 65, and goes against recommendations from NICE.
Guidance on breast cancer and osteoarthritis produced by NICE, and quoted in the report, recommends that age should not be a barrier to accessing surgical treatment.
The NICE Pathway on early and locally advance breast cancer says that all patients, irrespective of age, with early invasive breast cancer should be offered surgery, followed by adjuvant systemic therapy (rather than with endocrine therapy alone) unless significant comorbidity prevents surgery.
In addition, the NICE quality standard on breast cancer includes a statement that people with early invasive breast cancer, irrespective of age, are offered surgery, radiotherapy and appropriate systemic therapy, unless significant comorbidity precludes it.
NICE guidance on the care and management of osteoarthritis in adults recommends that patient-specific factors (including age, gender, smoking, obesity and comorbidities) should not be barriers to referral for joint replacement surgery.
But despite the advice and the incidence of breast cancer peaking in those over 85, the report found that surgery rates peak for patients in their mid-60s, and then fall sharply for people from around the age of 70.
Furthermore, hip and knee replacements are most likely to be offered to those up to the age of 75, despite life expectancy being 78 for men and 82 for women.
A spokesperson for the RCS said: “NICE guidance sets standards of practice for surgeons and healthcare professionals. We looked at the guidance, examining recommendations that cover age in particular.
“The NICE clinical guideline on breast cancer is very specific about age, in that it says age should not be a factor for treatment in its own right.
“We think that this recommendation really gets to the crux of the matter - that decisions on whether to provide treatment should not be based on any assumptions over the fitness of people at particular ages.”
Michelle Mitchell of Age UK added: “When it comes to peoples' health, their date of birth actually tells you very little. A healthy living 80 year old could literally run rings round someone many years younger who does not share the same good health.
“Yet in the past, too many medical decisions we believe have been made on age alone with informal ‘cut-offs' imposed so that people over a certain age were denied treatment.”
The report calls on clinicians to inform patients if surgery has been ruled out for a condition where it would normally considered, and provide reasons.
It also recommends that future NICE quality standards should follow the example set in the standard for breast cancer, which makes explicit reference to age.
This should occur for topics where evidence shows that older patients are not receiving the same high-quality treatment as other age groups.
17 October 2012