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Oncology Professional Care 2024
21-22 May at ExCeL London

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Assessing and managing an older cancer patient: Frailty assessment – national guidance and clinical implementation

21 May 2024
Living With and Beyond Cancer Theatre

Cancer is a disease of ageing. Therefore, the management of older adults is a crucial part of the routine practice for the cancer workforce. Nonetheless, several gaps of knowledge exist in geriatric oncology, along with a significant variation in the management of cancer and its outcomes within and between countries.

On the other hand, older adults with cancer are heterogeneous, and their management may be particularly complex. Therefore, geriatric assessments are crucial to inform a personalised and holistic treatment approach in a multi-disciplinary setting. Geriatric screening tools may assist with the selection of older patients requiring an oncogeriatric approach.

An integrated oncogeriatric approach is a standard of care supported by international consensus in view of the significant benefits associated with this model of care. These involve a better estimation of prognosis, the prediction of complications and physical decline on cancer treatments, the identification of problems not found by routine baseline assessments or new problems during follow-up care, the reduction in the rates of severe toxicities and unplanned hospitalisations and the improvement of quality of life on systemic anticancer therapy.

These benefits informed the development of the Joint Collegiate Council for Oncology guidance on Implementing frailty assessment and management in oncology services, such as The Royal Marsden Senior Adult Oncology Programme, the first consultative multi-disciplinary geriatric oncology care model implemented in a tertiary cancer centre in the UK.

The implementation of optimal clinical care models, fostering education in geriatric oncology, conducting research on the interface between cancer and ageing and collaborations with several stakeholders are instrumental to the advancement of the care of older adults with cancer at global level. Precision oncology for this population should take into account not only markers of tumour biology, but also geriatric assessments in the context of what matters to patient

 

The need for services with expertise in providing patient-centred care that is tailored to the unique needs of older patients with cancer has become increasingly clear in recent years.  National and international bodies have issued guidance recommending the use of geriatric assessment for all older patients commencing systemic anti-cancer treatment (SACT). Models of care for these patients have been developed and implemented across the UK and internationally.  Services are often located in tertiary or university hospitals with large cancer centres.

The Older Adult Cancer Service (OACS) at Chelsea and Westminster Hospital NHS Foundation Trust opened in March 2024, with 1-year proof-of-concept funding. Patients over 65 years starting SACT for a thoracic, urological, colorectal or skin malignancy, and identified as frail/vulnerable or as having other areas of clinical concern are eligible for referral to the OACS ‘one stop’ clinic and multi-disciplinary team meeting. 

Despite a smaller host department than in some larger centres, the OACS team comprises a clinical nurse specialist, an occupational therapist, a physiotherapist, a pharmacist, an oncologist, and a care of the elderly physician. Referrals are accepted directly from treating oncology teams and the OACS team undertake Comprehensive Geriatric Assessment (CGA) and lead on implementing or co-ordinating resulting interventions. Assessment findings and relevant interventions undertaken are fed back to the treating oncology team and GP. 

Alongside a pro-active hospital educational programme, clinical outcome measures are routinely collected to assist in understanding service impact, patient experience, and areas of improvement and unmet need, which also input into efforts to secure a long-term future for the service. A smaller department allows for efficient communications but carries additional challenges in terms of staff availability and estates management.

As geriatric oncology services develop, national and international forums have been created, which have proved to be invaluable for those working within the field both in terms of shared education, peer support and establishing clinical and academic networks. We aim to contribute the experiences of developing our service to this expanding body of knowledge. 

Speakers
Kwok-Leung Cheung, UK National Representative - SIOG
Nicolò Matteo Luca Battisti, Consultant Medical Oncologist - The Royal Marsden NHS Foundation Trust
Kirsty Balachandran, Specialist Registrar in Medical Oncology - Chelsea and Westminster NHS Foundation Trust

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