Ageism, while a relatively new concept in health care and oncologic discourse, is a pervasive, quotidian experience for the majority of older individuals in our society, and in our clinics. The concept of ageism incorporates the stereotypes (how we think), prejudices (how we feel), and discriminatory actions (how we act) that negatively affect how societies, practitioners, and individuals value and conceptualise older people and their experiences.
At least 90% of older adults encounter ageism daily, and ageist experiences can originate from within individuals, from their interpersonal interactions, and from external sources. Ageism is associated with poor outcomes for older individuals across multiple domains, including physical and functional health, mental health, cognitive function, quality of life, disease burden, and self-assessed health. Critically, older individuals affected by ageism are expected to live 7.5 years less than age-matched controls. As a contributor to health care expenditure, one in every seven dollars spent on health care every year is secondary to ageist beliefs, feelings, and actions, totally more than US $63 billion in the US alone.
Older patients with cancer face the prospect of double stigmatisation, that is, the negative perceptions of ageing, and those of living with cancer. Ageism-informed discrepancies in cancer screening, diagnosis, clinical trial enrolment, and cancer management negatively affect numerous cancer-related outcomes amongst older people, including quality of life and mortality. Even when adjusting for comorbidity burden, demographic factors, and tumour type, older patients with cancer have markedly decreased rates of histological confirmation, surgical intervention, and systemic therapy administration. This, in part, stems from the pervasively negative perceptions that our profession holds towards older people.
As we approach older individuals in our clinics, we must face our conscious and subconscious ageist biases, and proactively work to reduce, even eliminate, our devaluation of older individuals with cancer.