Mintra Dhani is a youthful 81-year-old who lives on her own, regularly works out and enjoys line dancing.
When she visited an emergency department in 2024 for a minor issue, she was surprised to receive a diagnosis for early-stage pancreatic cancer.
“I was in shock,” Mintra recalls. “I never thought I'd be the one in the family to get hit with this.”
As the reality of her diagnosis sunk in, Mintra became a part of a group of cancer patients who are often overlooked and underserved: Canadians over the age of 65. Though they only represent 17 per cent of the population, they account for more than 60 per cent of new cancer diagnoses.
Beyond smoking, alcohol consumption or even sun exposure, aging is the most important risk factor for cancer.
Many older adults also have other medical conditions, cognitive difficulties or limitations that affect their daily function, increase their vulnerability and make their cancer more complex to treat.
With these concerns in mind, Mintra's oncologist referred her to UHN's
Older Adults with Cancer Clinic (OACC) at Princess Margaret Cancer Centre, one of few specialized geriatric oncology clinics in Canada.
Mintra's daughter, Dr. Neesha Dhani, a medical oncologist at
Princess Margaret Cancer Centre at Princess Margaret Cancer Centre, was grateful for the referral, saying it helped her mother discuss the challenges of treatment.
Age-informed cancer care
Founded a decade ago, the OACC is seeing more patients than ever, due to Canada's growing and aging population.
“Our clinic has seen 2,200 patients in the last decade and we have influenced the oncological care of more than 40 per cent of them, providing personalized, comprehensive care tailored to the needs of older patients,” says Dr. Shabbir Alibhai, Medical Lead of OACC.
“Geriatric oncology should be embedded as standard of care in Canda.”
The goals of the clinical team are to identify the unique needs of older people with cancer and help them maintain function, independence and quality of life before, during and after treatment. Patients are referred by their oncologists who are concerned their patients may be more vulnerable, at a high risk of side effects, unable to manage their treatment, have other illnesses, or are physically or mentally frail.
Mintra recovered well from surgery, but had questions about the rest of her treatment. The geriatric oncology program did a brief physical exam, fitness test and interviewed Mintra, going over issues such as decision making, memory, social supports, fatigue and personal care.
Once the assessment was complete, Mintra felt more confident that her body could withstand chemotherapy. The clinic also asked if she would be interested in taking part in a clinical trial aimed at empowering older adults through online exercise and health education.
“I said, 'Yes, if you're doing research, I'm all for that.' I love the exercise portion and have never missed a session,” says Minha.
“I'm still tired and am not as strong as I used to be. But I appreciate the program and am looking forward to spending more time with my five grandchildren, and maybe finally getting back the strength to travel again.”
An urgent need across Canada
With older adults the fastest growing population in Canada and globally, the need for geriatric oncology is growing.
Dr. Alibhai is in touch with clinics in Ontario and Alberta that have geriatric oncology services under development and is helping pioneer this form of treatment across the country. The OACC is also active in research and conducts original research every year, attracting fellows and observers from around the world.
One challenge is a countrywide shortage of geriatricians. But with the expanding role of nurse practitioners in Canada, this option has a huge potential to improve care delivery and at a lower cost, says Dr. Alibhai.
Not all older adults with cancer will be able to receive specialized geriatric services. And not all will need them.
But a model of care that focuses on those who are most likely to benefit from tailored care, and that could include palliative care if they are too frail or choose not to proceed with aggressive treatment, can benefit quality of life and maintaining function.
“We aim to deliver a tailored treatment plan that not only treats cancer but preserves what matters most to patients: independence, dignity and joy,” says Dr. Alibhai.
