Over 65? Why some doctors think giving you the latest cancer drugs is just a waste.

Byline: JANE FEINMANN

WHEN Jenny Duffield told friends she was having surgery to reduce her risk of a deadly cancer, she was surprised when some of their reactions were lukewarm.

'We've all got to die some time, Jenny,' said one with a nudge, while another asked: 'Is it worth going to all that trouble at your age?'

Earlier this year, Jenny, 72, a retired nurse from Farnham, in Surrey, decided to have her ovaries removed after a genetic test indicated she was at very high risk of potentially fatal ovarian cancer - a risk that would disappear with the surgery.

'Almost everyone said how brave I was to have the operation at my age - as though I had a choice,' says Jenny, who is married with three children and four grandchildren. 'It seemed as though they didn't think it was worth my while.'

And it hasn't just been friends and neighbours who appear to have different views about cancer treatments offered to older women as opposed to younger patients.

Jenny's first experience of this came after both she and daughter, Belinda, 38, were treated for breast cancer. While Belinda was given what is widely regarded as the normal combination treatment - chemotherapy along with a mastectomy - Jenny was advised a mastectomy would be sufficient.

'I don't remember chemotherapy being discussed, but I was relieved as I've heard it can be worse than the cancer itself,' she says.

Alarming research is showing that elderly cancer patients are missing out on the breakthroughs in chemotherapy and surgery that have dramatically improved the outcome of younger patients.

In fact, up to 15,000 elderly people with cancer in the UK are dying prematurely every year when compared to the rest of Europe and the U.S., according to a report published by the North West Cancer Intelligence Service (NWCIS) which compiles cancer statistics.

A major factor with breast cancer is that elderly patients frequently either have surgery only - or simply get a prescription for hormonal treatments such as Tamoxifen or Arimidex, which suppress the female hormone oestrogen and slow down the growth of the cancer.

These drugs are prescribed for younger women, but almost always alongside a regimen, including chemotherapy, radiotherapy and surgery.

What's causing alarm is the extent to which an age-related double standard for breast cancer treatment has crept into hospital protocols.

'Older people are far more likely to be turned down for expensive new treatments,' says Kate Spall, founder of the Pamela Northcott Fund, set up in 2007 to campaign to help thousands of cancer patients gain access to new drugs. 'We always have a fight on our hands to get treatment for someone over 65,' she says.

Lung cancer treatment seems to be a particularly blatant example: at least one study has shown that chemotherapy brings significant benefits, even to lung cancer patients in their 80s with other health problems. Yet only 15 per cent of patients, overwhelmingly younger ones, get chemotherapy, according to a study from King's College London.

A major concern is that the NHS Cancer Plan, introduced in 2000 to improve cancer survival in the UK, has a cut-off point at 70. This results in hospitals having less interest in the elderly. 'Yet half of all those diagnosed with cancer are over 70,' says Dr Tony Moran, NWCIS research director. 'It's an area that has been grossly an area that has been grossly neglected.

'These days, most 75-year-olds can expect to live for at least another ten years and they should be benefiting from improvements in treatment.'

LAST June, a picture of what amounts to a twotier service emerged. A nationwide report to measure breast cancer outcomes found that around 15 per cent of patients over 65 are given chemotherapy compared to 77 per cent of patients under 50.

Then there is breast reconstruction - not a single woman over 70 has so far had breast reconstruction on the NHS.

So, is ageism behind a covert form of rationing in Britain's cancer wards? 'Cancer teams are always willing to offer appropriate treatment at all ages,' says Hugh Bishop, breast cancer surgeon at the Royal Bolton Hospital.

'But what's appropriate for someone over 70 is inevitably different to what is best for a younger person.

'It's common sense that older people face greater risk from having lengthy surgery under a general anaesthetic or taking very toxic drugs, especially when many will also have heart problems or other chronic conditions. Older people also know they're more at risk of MRSA. ' Yet, experts warn that however well meaning decisions are about treatment for Britain's elderly, too often they are stereotyped and outdated.

'Cancer teams make decisions about treatment for the elderly based on unproven generalisations about the risks of surgery and strong drugs in old age,' says Malcolm Reed, professor of surgical oncology at Sheffield University.

There is evidence showing that cancer surgery is beneficial for anyone with a life expectancy of more than two years, he says. And fit 70 to 75-year-olds are those most likely to get a raw deal and be denied chemo drugs that could prolong life.

Far more likely, it seems, is that once you hit 70, you're assumed to be 'elderly' - by which doctors mean frail, unhealthy or coping badly. 'What's happened is that doctors have slipped into this assumption because there's no clinical evidence as to whether older people benefit from chemotherapy,' says Professor Reed. 'Unfortunately, over-65s are excluded from most clinical trials because they are seen as always having multiple illnesses that will confuse the findings.'

He says the way forward is for cancer teams to ignore the chronological age of older patients and instead carefully assess their biological age by testing the state of different organs.

Kidney function, for instance, can deteriorate with age and if your kidneys are not working well and therefore unable to flush toxins out of the body, chemotherapy is usually inappropriate.

But it might also be possible to prescribe less toxic drugs. Such carefully considered decisions are not happening, says Jane Hatfield of Breast Cancer Care. 'Older patients get less time with health care professionals, whereas the opposite should be happening because treatment regimens are more likely to be complicated.'

Jenny Duffield can count herself fortunate that she got cancer at 65. Otherwise she would not have had a breast reconstruction after her mastectomy.

As research shows, women over 70 are automatically viewed as no longer in the market for this procedure - quite unfairly, says Chris Caddy, a plastic surgeon at Northern General NHS Trust.

National guidelines state any woman should have the opportunity to undergo breast reconstruction provided it is safe. 'Breast reconstruction,' says Mr Caddy, 'is very popular with younger women so the operation is obviously being presented to older women in the most offputting way.

'These women are also less likely to feel as possessive about their breasts as younger women. But if a woman really wants a reconstruction and is healthy enough to have it, she should be able to.'

Indeed, Jenny is delighted with her breast reconstruction. 'I'd always thought the roll of fat around my tummy would come in useful some day,' she says. She is also now nearing the five-year 'recovery' mark post-surgery and is fully recovered from the operation to remove her ovaries.

7 - the average number of years you add to your life expectancy if you reduce your salt intake by 30 per cent, according to Finnish scientists

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Tough decisions: Jenny Duffield is now recovering

Picture: JAMES ROBINSON