Care of the Elderly: Cherry Ward
Assessing the Needs of Elderly Cancer Patients Up Front Results in Better Care
New guidelines clarify how to best assess the real-world needs of cancer patients ages 65 and older.
By Shari Roan
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June 5, 2019
Cancer patients who are ages 65 and older have unique needs and vulnerabilities and should be managed with their age in mind, according to research presented June 1 at the 2019 annual meeting of the American Society of Clinical Onocology (ASCO) in Chicago.
A large, randomized, controlled study presented at the meeting found that when older patients undergo standardized geriatric assessments on issues such as cognitive impairment or the risk of falling, they have better-quality conversations with their cancer doctors and feel more satisfied with their care.
The study comes at a time when cancer doctors are rethinking the care of their older patients. The first-ever guidelines to improve geriatric cancer patient care were published May 21, 2019, in theJournal of Clinical Oncology.
The guidelines will help oncologists assess the needs of older patients and manage problems and issues that frequently occur in this age group, says Supriya Gupta Mohile, MD, professor of medicine and surgery at the James Wilmot Cancer Institute at the University of Rochester in New York, and director of the Geriatric Oncology Clinic.
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Aging Population Means Older Cancer Patients
The guidance is important because the risk of developing cancer increases with age, and many more Americans are living longer. More than half of all cancers are diagnosed in adults who are age 65 or older. The chances of developing cancer after age 70 is 1 in 3 for men and 1 in 4 for women.
“The fastest-growing population of patients with cancer are those 70 and older,” Dr. Mohile says. “Most older patients with advanced cancer treatment only want treatment if it does not negatively affect other health issues.”
Geriatric assessment is a common tool that examines several factors impacting the lives of older patients, including health conditions, physical ability, issues with memory or falling, cancer symptoms, medication that affects chemotherapy, and the patient’s at-home care-giving support system.
“While geriatric assessment has been shown to be feasible, only 20 percent of community oncologists use geriatric assessment in clinical practice,” says Mohile.
Oncologists should individualize cancer treatment for geriatric patients to improve treatment decision-making and quality-of-life concerns, she says.
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Geriatric Assessment: A Simple Way to Improve Quality of Care
Mohile, a board-certified geriatrician and oncologist, founded a geriatric oncology clinic at the University of Rochester that is one of the few such centers in the country devoted to older patients. In the new study, she looked at whether using geriatric assessment, and providing the oncologists with a summary of the patient’s geriatric-related issues and a list of recommendations, improves communication with patients.
The followed 544 patients ages 70 and older with advanced solid-tumor cancers or lymphoma. All of the study participants had at least one geriatric-related impairment.
The trial was randomized so that half of the oncologists received their patients’ geriatric assessment summaries and recommendations while the other half did not. The clinical visits were recorded, transcribed, and coded to provide objective scores on the quality of the doctor-patient discussions. Telephone surveys were also completed with the study participants to gauge their satisfaction.
The study found that patients whose oncologists received the geriatric assessment summary and recommendations had more discussions regarding geriatric concerns compared with the control group — and more of those discussions were considered high-quality. This group of patients also had more geriatric-related interventions and reported more satisfaction with their care compared with the control-group patients.
“This is a very important study that is likely to have a direct impact on the care of our older patients with cancer,” says Joshua Jones, MD, an assistant professor of clinical radiation oncology at the University of Pennsylvania, who was not involved with the study. “With a simple, validated assessment, we can make sure we understand what is most important to our patients and provide the right kind of care that they want.”
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Special Needs of Older Cancer Patients in the Spotlight
The study lends support to the new ASCO guidelines recommending geriatric assessment in patients who will receive chemotherapy, says Mohile. These guidelines recommend screening geriatric patients for depression, cognitive impairment, nutritional status, and other geriatric issues. Evidence-based tools are also available to oncologists to help assess the potential toxicity of chemotherapy in older patients.
Research has accumulated in recent years demonstrating the usefulness of a geriatric assessment. Studies have found that such assessments can identify patients who are at risk for poor outcomes from cancer treatment, Mohile says. Doctors, patients, and caregivers should focus on how to best improve communication among all parties to enhance care and honor what patients and their caregivers want and need, she says.
Oncologists, patients, and caregivers may not understand that it’s important and appropriate to discuss age-related issues, like memory problems or a lack of social support.
“In general oncology clinics, we are very focused on the cancer and treatment,” she says.
Video: gnec podcast assessment and management of cancer related to older adults with complex care needs 6
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