A synopsis of geriatric cancer in Bangladesh
The care of the aged is called clinical gerontology or geriatrics. Ageing is a biological phenomenon and refers to a slow imperceptible, progressive and degenerative process advancing with chronological age leading to increased functional deterioration and vulnerability, ultimately culminating in the extinction of life.
Although there is no internationally accepted age bracket for defining the elderly population, people aged 60 years or above are considered as elderly in most gerontological literature. The elderly population in the context of Bangladesh has been defined as those who have reached 60 years of age.
Geriatric oncology is the branch of medicine that deals with the diagnosis and treatment of elderly cancer patients. Cancer is the main cause of death in the elderly population and an important cause of their suffering.
In western countries, the diagnosed malignancy in the population over 65 years of old age is approximately 60% and the age-adjusted cancer incidence rate of 2,151/100,000 of the population. The risk of cancer development in the geriatric group of patients is 11 times or more in comparison to younger people.
The incidence of cancer is also increasing with the increase of age and more than 12-23% of all cancers occur in geriatric patients and are gradually increasing day by day. But these patients receive less attention in terms of diagnosis and treatment.
The geriatric population of Bangladesh mostly suffers from cancers of the lung, oral cavity, larynx, breast, oesophagus, cervix, stomach, urinary bladder etc. Due to the longer life expectancy of Bangladeshi people, the cancer burden is also increasing. One study of a private cancer hospital in Bangladesh shows the prevalence of geriatric cancer is about 33.77%.
Lung cancer is the most prevalent cancer in this study. Bangladesh has no definitive cancer registry for geriatric cancer, the study compared with few articles of the South Asian subcontinent and found that many previous Indian studies also reported lung cancer is the most prevalent malignancy in the geriatric age group of population.
Oral cancer is the second prevalent cancer. Smoking, betel nut chewing, absence of a national screening programme, inadequate access to health care, poverty, limited awareness etc. are the major contributing factors for these top two malignancies.
It is observed that lung cancer is the most prevalent malignancy among male geriatric patients followed by laryngeal and oral cavity cancer. As lung cancer and oral cavity cancer are the most frequent malignancy among males and are showing increasing trends in our country, it has become a major public health issue and control of tobacco use should be a priority. Tobacco control will not only reduce tobacco-related cancers but also many other chronic diseases. In the case of the female geriatric population, the most prevalent malignancy is breast cancer followed by cervical cancer. The incidence of breast and cervical cancer can be reduced significantly if there are screening programmes at the primary, secondary and tertiary levels of Bangladesh.
Geriatric cancer patients deserve special care and attention from all the health care faculties in terms of their diagnosis, treatment and follow-up care. It is also very much important to treat the coexisting disease along with cancer as the elderly may possibly harbour many other chronic diseases to ensure better quality of life.
The writer is the Head of the Department of Oncology, Delta Medical College and Hospital, Bangladesh. E-mail: manzur2001bd@yahoo.com