Interview with Prof. Dr. Wolfgang Hoffmann: Cancer as a typical disease of old age

The implications of developing trends in elderly cancer incidence and care were addressed by Prof. Dr. Wolfgang Hoffman, a care researcher at the Institute for Community Medicine, Greifswald, Germany.

Increasing numbers of older cancer patients will also be affected by several chronic diseases in the future

The implications of developing trends in elderly cancer incidence and care were addressed by Prof. Dr. Wolfgang Hoffman, a care researcher at the Institute for Community Medicine, Greifswald, Germany.

Almost half a million people in Germany are diagnosed with cancer every year. More than a third of them are 75 years or older. What this means for cancer care in Germany in the future is explained by Prof. Dr. Wolfgang Hoffmann, a care researcher at the Institute for Community Medicine in Greifswald and keynote speaker at the German Cancer Congress.

Question: Professor Hoffmann, on behalf of the German Society of Hematology and Medical Oncology (in German: Deutschen Gesellschaft für Hämatologie und Medizinische Onkologie), you analyzed the future evolution of age-associated cancers in Germany in 2019. What is your prediction?

Prof. Hoffmann: Demographic change will lead to a 15 to 20 percent increase in the proportion of people over 60 in our population by 2025. In percentage terms, the proportion of over-80s will increase even more strongly, by 35 to 40 percent - especially in eastern and northern Germany. This development goes hand in hand with an increasing number of new cancer cases, especially those that occur more frequently in older people. Examples include stomach, intestine, pancreas, lung, prostate, and bladder cancers. According to our estimates, 2.85 million people in Germany will be living with cancer by 2025. Among men, it is mainly patients with prostate and kidney cancer and malignant melanoma who need long-term care. Statistically speaking, female patients with breast, uterine cancer, and melanoma have the highest probability of long-term survival.

Question: What are the particular care needs of older people with cancer?

Prof. Hoffmann: Parallel to the increase in cancer incidences up to 2025, the number of those who suffer from diabetes mellitus, chronic obstructive pulmonary disease, coronary heart disease, obesity, or dementia, in addition to tumor disease, will also increase. This means that more and more elderly people suffering from cancer will also be affected by one or even several of these chronic diseases. The concomitant morbidity, in many cases also multimorbidity, must be carefully considered during treatment. Beyond that, however, it is not only a question of the concomitant diseases, but also of the general physical condition and the living conditions of our patients: Are they mobile and can they still take care of themselves at home, or do they need special support in their everyday life at home, for example in regularly taking medication, shopping or personal hygiene?

Question: How can we find out what resources and care needs older patients have?

Prof. Hoffmann: Through a so-called geriatric assessment. This is a standardized procedure that records the medical, functional, and psychosocial resources and problems of elderly patients. Such procedures are important, because, during medical consultation hours, the need for care in the home environment is often not immediately apparent - many elderly people try to appear as fit as possible when visiting a physician, even if everyday life at home is difficult for them. Patients who are 70 years old or older and who have a particularly complex geriatric care need, be it due to the nature, severity, and complexity of their illness. And specific to the German context, they are entitled to specialized geriatric care according to §118a of the Social Security Code.

Question: Especially in rural areas, we expect to have fewer and fewer specialists available for cancer patient care. How can we ensure that older patients are not left behind?

Prof. Hoffmann: Diagnostics, therapy decisions, and patient treatment measures should be carried out at qualified centers that are experienced in dealing with these cases, which are often medically very complex - even if this means that treatment cannot always be carried out in the immediate vicinity of the patient's home. It is important that the centers work closely with the service providers at the place of residence so that patients receive optimal care even after the transition from the center to outpatient care close to their home. This also means that expert care is needed to initiate and coordinate all necessary measures and arrangements. Patients at home are often overwhelmed by this.

Question: What could such coordination look like in concrete terms?

Prof. Hoffmann: The establishment of a pilot function is planned in the German state of Mecklenburg-Western Pomerania. The idea for this first arose in Saxony: oncological patients are given a contact person by the health insurance company - that is, the contact visits the patients at home. We have had a very good experience with a similar model for dementia patients. Our study there showed that details relevant to care are often overlooked if the individual home environment is not taken into account sufficiently. Although the affected persons had regular appointments with their family physician, an average of about eight care needs per person were identified that had not been addressed before. I believe that a very important key to good care for older cancer patients is also to be found by those coordinating contact persons on site. At the German Cancer Congress, we want to discuss how this can be implemented even better than before, especially in rural areas.