Older Adults with Cancer Could Be Better Served

Vulnerable populations in Canada receive inequitable healthcare due to inadequate healthcare delivery that lack inclusion of addressing the determinants of health for diverse cultures, resulting in poor health outcomes (Richmond & Cook, 2016). Adults 65 years of age and older are an example of a vulnerable population.

Older Adults with Cancer

Given that the number of older Canadians is expected to more than double within the next 25 years, there will be a corresponding increase in new cancer cases, with the majority of those occurring among older adults (Canadian Cancer Statistics, 2015). Older adults are a growing population who have unique healthcare needs due to functional, cognitive, and mobility impairments that can make managing their cancer care complex (Bond, Bryant, & Puts, 2016; Burhenn et al., 2016; Magnuson et al., 2016).

Healthcare inequity for this population. Adults 65 years and older receive suboptimal cancer care in Canada, leading to poor outcomes such as functional decline, hospitalization, increased morbidity and mortality (Bond et al., 2016; Extermann et al., 2005; Hurria et al., 2012).

Healthcare barriers. Barriers exist for older adults in accessing equitable cancer care due to ageist structures, preventing their care needs from being meet adequately, as healthcare professionals often work in culturally incompetent healthcare systems that lack policies and processes that incorporate the necessary geriatric assessment tools and resources to identify vulnerabilities and frailty in older adult’s health (Clarke et al., 2014; Davidson et al., 2011; Neysmith, 2018).

Frailty. Frailty refers to the adaptive capacity of an individual, or the way in which they are able to respond to stressors, such as cancer treatment (Ethun et al, 2017). When an individual is fit the removal of a stressor will allow a person to rebound back to their baseline health status; however, in those with limited adaptive capacity, the recovery is decreased after the removal of the stressor resulting in poorer outcomes during and after cancer treatment (Ethun et al, 2017). Frailty has direct impact on quality of life, risk of institutionalization, falls, fractures and mortality (Davis et al., 2011).

How Can They Be Served Better?

Systematically identifying frailty when assessing older adults is a first step in tackling this issue and oncology nurses are ideally situated within the care team structure to do this the most effectively, yet currently they are facing system barriers (Burhenn et al., 2016). When health care professions use specialized geriatric assessment tools when assessing older adults with cancer, research shows a reduction in toxicity of cancer treatment and increases tolerance of cancer treatment, improving cancer-related outcomes (Extermann et al., 2005).

To resolve this issue of cultural incompetence, Cancer Care organizations should lead change by adopting transformational, adaptive, culturally competent, and socially just leadership styles (Arieli et al., 2012; Brown, 2004; Daft, 2015; Horvat et al., 2011; Lynch et al., 2018) to combat institutional barriers from the ground up to advance the standard of cancer care for older adults.

Resources

Arieli, D. D., Friedman, V. J., & Hirschfeld, M. J. (2012). Challenges on the path to cultural safety in nursing education. International Nursing Review, 59(2), 187-193. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1466-7657.2012.00982.x

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497553/pdf/12815076.pdf

Bond, S. M., Bryant, A. L., & Puts, M. (2016). The evolution of gero-oncology nursing. Seminars in Oncology Nursing, 32(Gero-Oncology Nursing), 3-15.

Brown, K. M. (2004). Leadership for social justice and equity: Weaving a transformative framework and pedagogy. Educational administration quarterly, 40(1), 77-108.

Burhenn, P. S., McCarthy, A. L., Begue, A., Nightingale, G., Cheng, K., & Kenis, C. (2016). Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG). Journal of Geriatric Oncology, 7(5),315-324. doi: https://doi.org/10.1016/j.jgo.2016.02.006

Canadian Cancer Statistics (2015).Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada, Provincial/Territorial Cancer Registries cancer.ca/statistics.Retrieved from: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20informat ion/cancer%20101/Candian%20cancer%20statistics/Canadian-Cancer-Statistics-2015 EN.pdf?la=en

Daft, R. (2015). The Leadership Experience(6th ed.). Stamford, CT: Cengage Learning. https://epdf.tips/the-leadership-experience-with-infotrac.html

Davis, D. H., Rockwood, M. R., Mitnitski, A. B., & Rockwood, K. (2011). Impairments in mobility and balance in relation to frailty. Archives of gerontology and geriatrics, 53(1), 79-83.

Ethun, C. G., Bilen, M. A., Jani, A. B., Maithel, S. K., Ogan, K., & Master, V. A. (2017). Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology. CA: a cancer journal for clinicians

Extermann, M., Aapro, M., Bernabei, R., Cohen, HJ., Droz, JP., Lichtman, S., . . . Topinkova, E. (2005). Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Critical Review Oncology Hematology, 55(3), 241-52.

Hurria, A., Browner, I.S., Choen, H.J., Delinger, C.S., deShazo, M., Extermann, M., . . . Wildes, T. (2012). Senior adult oncology. National Comprehensive Cancer Network, 10(2).

Horvat, L., Horey, D., Romios, P., & Kis-Rigo, J. (2011). Cultural competence education for health professionals. Cochrane Database System Review, 10.

Lynch, B. M., McCance, T., McCormack, B., & Brown, D. (2018). The development of the Person-Centred Situational Leadership Framework: Revealing the being of person centredness in nursing homes. Journal of Clinical Nursing, 27(1/2), 427-440.

Neysmith, S. M. (2018). Using Ageism as a Lens for Challenging Inequities in Home Care. Social Work and Policy Studies: Social Justice, Practice and Theory, 1(001).

https://openjournals.library.sydney.edu.au/index.php/SWPS/article/view/11591/11516

Richmond, C.A.M., & Cook, C. (2016). Creating conditions for Canadian aboriginal health equity: The promise of public health policy. Public Health Reviews, 37. doi: 10.1186/s40985-016-0016-5 https://publichealthreviews.biomedcentral.com/track/pdf/10.1186/s40985-016-0016-5

My Pocket page containing resources on vulnerable populations, older adults, and much more.

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Retrieved from: Improving Quality of Cancer Care for Older Adults | Cancer.Net

Retrieved from: Cultural Competence Assessment Tools | eCALD