INTRODUCTION
Some may argue that when an older person (65 years and older) presents to primary care with symptoms that may represent cancer, they should not be investigated differently from younger patients (less than 65 years). We think that cancer risk management in older people requires a more personalised approach. Recently, there has been a significant increase in knowledge regarding the management of possible cancer symptoms in primary care.1 However, this knowledge is not age related, and research on the specific diagnostic management of symptomatic older people is scarce, despite older age being associated with greater likelihood of developing cancer. This editorial will explore the issues that are specific to the management of older people with a potential cancer diagnosis, identifying gaps in our knowledge base, and highlighting the need for more research to underpin good practice.
CURRENT EVIDENCE AND BEST PRACTICE
The National Institute for Health and Care Excellence (NICE) released guidelines in 2015 on the recognition and referral of suspected cancer in primary care.2 While the guideline provides lower age limits for investigation and referral of specific symptoms it has no upper age limits, it does not specifically discuss older age when recommending investigation or referral, nor does it consider frailty, quality of life, or comorbidities. The guidance recommends discussing patients’ preferences about investigations and their potential risks and benefits, but states that there is no evidence on the information needs of older people. In fact, older people are significantly underrepresented in the evidence base underpinning the NICE guidelines. If colorectal cancer is taken as an example of a cancer with a peak incidence in 85–89 year olds, the guidance is based on 31 studies. In five of …
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