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Aging US population poses huge challenge for cancer care

WASHINGTON — The United States faces a crisis in how to deliver cancer care as baby boomers reach tumor-prone ages and doctors have a hard time keeping up with complex new treatments, government advisers reported Tuesday.

The caution comes as scientists learn more than ever about better ways to battle cancer.

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And while doctors try to optimize treatment, the Institute of Medicine found daunting barriers to achieving high-quality care for all patients. Overcoming those challenges will require changes to the health care system, and savvier consumers.

“We do not want to frighten or scare people who are getting care now,” said Dr. Patricia Ganz, a cancer specialist at the University of California, Los Angeles, who chaired the panel.

But too often, decisions about cancer treatments are not based on good evidence, and patients might not understand their choices and what to expect, the panel found. Some studies suggest that two-thirds or more of cancer patients with poor prognoses incorrectly believe the treatments they receive could cure them.

Topping the list of recommendations is finding ways to help patients make more informed decisions.

“The patient can’t be passive,” Ganz said. “It’s an important partnership that we need.”

The risk of cancer increases with age, and older adults account for just over half of the 1.6 million new cases diagnosed each year. By 2030, new diagnoses are expected to reach 2.3 million a year. The report warns there might not be enough oncology specialists.

Perhaps a bigger concern is the growing complexity of care. Increasingly, scientists are finding genetic differences inside tumors that help explain why one person’s cancer is more aggressive than another’s. More importantly, that also means certain cancer drugs will work for, say, lung cancer in one person but not the next.

It is not just a matter of knowing the latest treatments, but deciding whether they are worth it. Of 13 cancer treatments approved by the FDA last year, only one was proven to extend survival by more than a median of six months, the report said. The drugs all cost more than $5,900 for each month of treatment.

For older adults, treatment decisions can be even more complicated because the studies that test different therapies do not include enough people over age 65, who tend to have multiple health problems along with cancer, Ganz explained.

Nor are cancer teams doing a good enough job in educating and training patients’ loved ones to offer at-home care.

The Institute of Medicine advises the government about health issues. Among its recommendations are: more research on how to best treat different patients; new strategies to help doctors keep up with that evidence; and development of tools to communicate choices to patients so that they understand what might happen to them.

The panel had advice for people who need to know if they are getting quality care. Take the time to research care options and get a second opinion, Ganz emphasized. Among the questions to ask:

 How long does the average person with this cancer live?

 What is my likelihood of a cure?

 If I cannot be cured, will I live longer with treatment? How much longer?

 Will this care directly treat the cancer?

 What are the side effects?

 Am I eligible for trials?

If your health team does not have answers, “you need to find another set of providers,” Ganz said.

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