Older, Wiser — and Cast Aside by Cancer

These mature patients are challenging medicine as never before

Great strides in cancer care mean more patients survive the disease — but is the health care industry prepared to adequately care for these survivors?

That question puzzled researchers, prompting them to undertake and publish a new study entitled “Anticipating the Silver Tsunami” in the July 2016 edition of Cancer Epidemiology Biomarkers & Prevention.

The health care industry is slowly re-adjusting to a view of cancer as a chronic illness.

Forty percent of men and 25 percent of women 90 years old and older are cancer survivors. By 2040, 73 percent of all cancer survivors will be 65 or older.

But instead of learning more about how to care for these patients, and learning more about survivors’ health challenges, patients over the age of 65 are largely omitted from clinical studies and trials, according to the research. On top of that, there are challenges with insurance — so older citizens may experience cancer care that differs greatly from those under 65.

Since cancer survivors are more likely to develop additional conditions after treatment for cancer, they may have more complex health care needs than non-survivors. Those conditions make them unlikely for research projects; the complications can skew numbers.

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The most common subsequent health issues to emerge after surviving cancer are diabetes, congestive heart failure, and chronic obstructive pulmonary disease (COPD) — although kidney, liver, and immune system diseases are common, too.

As surviving cancer becomes more common, due to early detection and better treatments, the health care industry is slowly re-adjusting to a view of cancer as a chronic illness. Sixty-four percent of all survivors have lived five years past diagnosis, while 40 percent have lived 10 years past diagnosis.

[lz_bulleted_list title=”Cancer Survivors in U.S.” source=””]68% have survived 5 years or more|44% have survived 10 years or more|20% have survived 20 years or more[/lz_bulleted_list]

“This combination of attributes in the cancer survivor profile (i.e., advanced age, longevity, and multiple health conditions) may foreshadow a ‘silver tsunami’ of cancer survivors whose health needs we are unprepared to meet,” according to the research article.

One of the bigger concerns is access to treatment, which will affect a patient’s prognosis. Since there’s great pressure to keep costs low, many therapies, drugs, and experimental processes are not covered for Medicare users. Precluding patients over the age of 65 from specific medical procedures and treatments isn’t rare or unusual, largely due to the fact that most seniors rely on Medicare for insurance.

“Medicare Advantage excludes medical trial programs,” Christopher Grimmond of Omaha Insurance Solutions in Nebraska told LifeZette. “The monitors at the contracted insurance companies can decide which cancer treatments are appropriate. There is a huge institutional, financial, and political squeeze to limit medical costs among the elderly.”

Under Medicare Advantage, treatments are limited, and care and costs are managed.

Medicare Advantage membership grows in the double digits every year, but the program lacks full disclosure, said Grimmond.

“If clear rules and guidance on the issues that people deal with every day was put in writing for all to see, then groups of people could take it to their representative in Congress or to the press and rain a firestorm down on them,” Grimmond said. “It’s usually a single, isolated, sick — and, many times — poor individual who is denied. They have no means or mechanism for appeal. Then they die.”

One of Grimmond’s clients on Medicare Advantage wanted to be accepted to an experimental cancer program. The hospital and program refused to contract with the Medicare Advantage insurance company; his request was denied.

“He spent six hours on the phone, pleading with Medicare to grant an exception and release him from the Medicare Advantage plan, so that he could go back to original Medicare, because the treatment program he wanted would accept original Medicare,” Grimmond said.

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Under traditional Medicare, patients can access alternative and experimental treatments, but there is no limit on the copay. Expenses mount quickly, and many don’t qualify for supplemental insurance because of the existing cancer condition.

Under Medicare Advantage, treatments are limited, and care and costs are managed.

Those eligible for Medicare can switch from program to program only during the annual open enrollment period of Oct. 15 to Dec. 7.

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It’s not a scenario focused on optimal outcome — nor is it one anybody wants to face, for themselves or a parent. It has the potential to take decisions away from the patient completely, especially because the industry anticipates upcoming shortages of oncology and primary care doctors.

Responsibility for surveillance and advocacy for the patient will also likely fall on a person who is already ill, or family members — and important decisions on care will be decided by a committee from the Center for Medicare and Medicaid Services.

“A committee decides what treatment would be available for Grandma and Grandpa,” Grimmond said, “and it’s all about cost savings.”

Pat Barone, MCC, is a professional credentialed coach and author of the Own Every Bite! bodycentric re-education program for mindful and intuitive eating. 

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