Blood Cancer in the Elderly: European Expert Forum, Rome, 19—20 March 2011
Professor Joerg Hasford (Ludwig-Maximilians-Universität, Germany)
Treatment barriers for elderly patients
Patient advocacy is a big topic; an important topic here in Rome at the meeting on Blood Cancer in the Elderly. Professor Hasford from the Ludwig-Maximilians-Universität in Munich, you are a specialist on this because you have been looking at things like equal access and you have discovered that older people don’t necessarily get full access to some cancer treatments.
Yes, that is true and that was quite a surprise for us. I work in particular in chronic myeloid leukaemia which is a disease that is primarily occurring in elderly patients and since a couple of years there is a very good new treatment with remarkable success. So it made sense to check whether all patients get equal access to treatment. A surprising finding for us was that they don’t. In particular, elderly patients, and this starts already at the age of 50, get less and less likely the new treatment.
So even in a disease like chronic myeloid leukaemia where imatanib and its sister drugs have brought in a completely new era in terms of survival, even then you are finding there is discrimination against older people?
Yes. There is very little doubt. The database that we accessed is representative of a population of about 10 million people, and there are about 1,000 outpatients in it and there is no doubt, the older you are the less access you get to modern, state of the art treatment.
And from your epidemiological studies have you been able to show what in fact might be causing that age discrimination?
This is very difficult as we used databases of insurances and thus they do not allow us to answer the wide question of why does it happen. There is certainly one reason which I realise in discussing the results with physicians. When you read newspapers about life expectancy you always read, for example, a male in Germany has a median life expectancy of 76 years but what many physicians do not know is that the life expectancy is calculated on a condition of which age you have already achieved. So once you are born it is 76 years but when you are 60 years, that means you have achieved to the 60th birthday, and there are for males another 20 years and for women another 24 years; and if you have achieved to become 70 then there is for males another 13 years. And this seems to be not known by many physicians that it makes a lot of sense to give an elderly patient, for example of 70,a very modern drug which allows for a life expectancy let’s say for another 10 or 15 years as this is the normal life expectancy of these patients.
Do you think that it is only in chronic myeloid leukaemia, or what about other cancers; do you think the same thing is happening?
I don’t have empirical data about that but one also has to keep in mind that not in all haematological cancers there is such progress available with regard to treatment. So it might not be that relevant to have access to the most modern treatment, in particular if they are, let’s say, also more pronounced on the toxic side. But with regard to chronic myeloid leukaemia the tyrosine kinase inhibitors are fairly well tolerated even by elderly patients, but at the same time they provide, as I have said already, considerable progress with regard to survival time. And we have also done an additive with regard to prognosis of the disease and with the tyrosine kinase inhibitor age is not any more a prognostic factor.
That’s amazing, and clearly there are treatments for older patients. What do you think doctors should be doing about this?
In general I think age should not be a decisive factor in selecting a treatment. You should always look at the patient and their biological state and not at the age status. If the patient is fit and has not a lot of serious comorbidity he or she should always receive the current state of the art treatment. That is my definite opinion.
Professor Hasford, thank you very much indeed.
You are welcome.