At what age is multimodal therapy and surgery no longer affordable? (#57)
As the population ages and major surgery for oesophageal cancer becomes safer; more and more elderly patients with co-morbidities are being deemed suitable for radical treatment. The aim of this presentation is to evaluate the changing role of multimodal treatments in the elderly population and their cost implications.
There have been major changes in oesophageal cancer in the Western world. Not only in epidemiological terms, with the dramatic increase in the proportion of adenocarcinoma of the oesophagus but also in available management strategies. There have been advances in surgical techniques, neoadjuvant and adjuvant therapies and there are a swathe of potentially expensive targeting drugs currently under evaluation, such as monocolonal antibodies to a variety of growth factor receptors. The role of these multimodal, radical treatments in oesophageal cancer are still being defined through a number of randomized controlled studies. However, the majority of patients present with advanced disease and hence could be suitable for these complicated and expensive management pathways.
Oesophageal cancer is generally a disease of older age with the highest incidence in the 7th and 8th decades of life. The ageing population, the rising incidence and safer surgery, places increasing pressure on services to accommodate cases that previously would not have been deemed suitable for radical therapy.
So what is the cost of this? Is this simply a monetary and capacity issue or is this more complex with societal and morbidity issues being ignored. How do we and how should we select patients? What are the implications for the service currently and for the future?