Comprehensive Geriatric Assessment in Oncology: Best Practices in Caring for Older Patients

Overcash, Janine; Ford, Neil B.; Hp, Erdeljac; Fugett, Susan; Knauss, Brittany; Kress, Elizabeth; Utendorf, Cari; Noonan, Anne M.

doi:10.6004/jadpro.2018.9.6.6

JADPRO

2018

DOI: 10.6004/jadpro.2018.9.6.6

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Comprehensive Geriatric Assessment in Oncology: Best Practices in Caring for Older Patients

Janine Overcash¹,

Neil B. Ford²,

Erdeljac Hp³

et al.

Abstract: Michele Green received the results of her breast cancer biopsy last week. Before surgery for infiltrating ductal carcinoma to her left breast, Michele was advised to meet with the members of the Senior Adult Oncology Program (SAOP) at the cancer center. A phone call from a nurse explained that the 2-hour visit with the SAOP would include meetings with many providers, such as a physical therapist, a social worker, a dietitian, a pharmacist, a nurse practitioner, and an oncologist to undergo a comprehensive geri… Show more

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Cited by 4 publications

References 14 publications

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Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Verduzco-Aguirre

Guerra

Culakova

et al. 2022

JCO Global Oncology

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PURPOSE There is limited information regarding the use of the geriatric assessment (GA) for older adults with cancer in developing countries. We aimed to describe geriatric oncology practice among Mexican oncology professionals and to identify barriers and facilitators for the implementation of GA into the routine care of older adults with cancer in Mexico. METHODS We conducted an explanatory sequential mixed-methods study. We administered an online survey to cancer specialists in Mexico about the routine use of GA and barriers for its use. We then conducted online semistructured interviews with survey respondents selected by their use of GA, expanding on barriers and facilitators for performing GA. Descriptive statistical analyses were performed for quantitative data; qualitative data were analyzed inductively through thematic analysis. We developed joint displays to integrate quantitative/qualitative results. RESULTS We obtained 196 survey responses: 37 physicians (18.9%) reported routinely performing a GA. Medical oncologists ( P = .002) and physicians seeing ≤ 10 patients/day ( P = .010) were more likely to use GA. The most frequent barriers for GA use were lack of qualified personnel (49%), limited knowledge (43.9%), and insufficient time (37.2%). In the interviews (n = 22), the limited availability of geriatricians was commonly mentioned. Respondents highlighted the lack of geriatric oncology knowledge among cancer specialists and geriatricians. Saturation of oncology services and a lack of effective referral pathways for GA were also common issues. Facilitators included availability of geriatricians, system/administrative facilitators, presence of a multidisciplinary team, and availability of geriatric oncology education. CONCLUSION The routine use of geriatric oncology principles in Mexico is limited by the availability of qualified personnel and by insufficient knowledge. An educational intervention could improve the implementation of GA in cancer care.

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Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Verduzco-Aguirre

Guerra

Culakova

et al. 2022

JCO Global Oncology

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Timed Up and Go: Reference Values for Community-Dwelling Older Adults with and without Arthritis and Non-Communicable Diseases: The Tromsø Study

Svinøy¹,

Hilde²,

Bergland³

et al. 2021

CIA

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Purpose The Timed Up and Go (TUG) test is used to assess a person’s mobility and balance. We aimed to provide updated reference values for TUG performance for the community-dwelling older population according to age and sex, and according to the presence of arthritis and non-communicable diseases (NCDs). Participants and Methods Cross-sectional data from the seventh wave (2015–2016) of the population-based Norwegian Tromsø Study counting 5400 community-dwelling people (53% women), aged 60–84 years were used. Reference values were presented as percentiles and means for men and women by age at five-year intervals. Results Median TUG score was stable during age 60–65 years, and after age 65 years median TUG score increased significantly with age (increase by 0.14 sec per 1 year higher age in both men and women, p<0.001). At the youngest ages (<65 years), in both men and women, there were no differences in TUG performance for those with NCD or arthritis compared to those without these diseases. After age 65 however, those without these diseases performed significantly better (p<0.05) in both men and women. Conclusion The present study provided percentile reference values for TUG performance in community-dwelling older adults in Norway by age and sex, and in subgroups of those having arthritis and NCDs. TUG scores increased with age, and performance was significantly poorer among participants with arthritis or NCDs after age 65 years. The findings may guide clinical interventions for individuals with mobility and balance disabilities.

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Challenges in Geriatric Oncology—A Surgeon’s Perspective

Parks

Cheung

2022

Current Oncology

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As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient’s vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians—a shared care approach between surgical oncologists and geriatricians is required.

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Comprehensive Geriatric Assessment in Oncology: Best Practices in Caring for Older Patients

Cited by 4 publications

References 14 publications

Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Barriers and Facilitators for the Implementation of Geriatric Oncology Principles in Mexico: A Mixed-Methods Study

Timed Up and Go: Reference Values for Community-Dwelling Older Adults with and without Arthritis and Non-Communicable Diseases: The Tromsø Study

Challenges in Geriatric Oncology—A Surgeon’s Perspective

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