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Inequitable access to prevention, diagnosis, treatment and care for older…

- - - - Concerns over the growing costs of cancer
      - Perceived dichotomy between investing for children/working age adults and older adults
    - - Little conversation across the global health community on cancer in older adults
      - Limited guidance about a core/essential package of services for older adults with cancer
  - - - Limited guidelines of management of cancer alongside other conditions in older adults
    - - Decline in physical capacities
      - Cognitive decline
    - - Availability of tools
      - Capacity (particularly time) for clinical teams to use them
      - Clinical staff not familiar/trained to use tools
      - Framework for assessing where these are needed and where these are not/ different levels of tools
    - - Culture change (i.e. potential to deviate from curative goal & recognising that this is not a failure)
      - Patients not empowered to request/express preferences in treatment
  - - - Delays in referral
      - De-prioritisation of treatment for older adults
        
        Few legal protections for older adults being denied/ delayed treatment (cf. UK law)
    - - Limited/ no development in age-friendly services as older adults not considered or prioritised in health-system planning
      - Poor awareness of guidelines/recommendations around development of age-friendly facilities and systems
  - - - Not always taught by specialists
    - - Not always possible to pursue geriatric oncology as specialism (particularly LICs and MICs)
      - Limited financial support for training in geriatric oncology
      - Few training programmes to support career development and specialisation (including overseas in LMICs)
  - - - Limited availability of resource-stratified guidelines for older adults
    - - Excluded from clinical trials on the basis of age or co-morbidities
      - Less dissemination of findings from implementation science studies
  - - - Concerns over costs of cancer care amongst older adults bankrupting system
  - - - Concerns over use of resources/ wasting time
      - Concerns over cost
  - - - PHC workers not familiar with burden of cancer in older adults & presentation
        
        Not necessarily always included in core medical education
        
        Not necessarily included in continuing medical education therefore onus on individuals to keep up skills and awareness
    - - Limited evidence on effectiveness or guidelines
      - Concerns about over-screening and over-diagnosis
- - - - Multigenerational poverty
  - - - Loss of individuals from formal/informal employment (e.g. family support, childcare)
      - Loss of cultural history
    - - Fuels misconceptions around cancer e.g. death sentence
      - Human rights violation?
      - Psychological trauma (families, medical staff)