Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research

Abstract

This supplement is a compilation of original work that was presented at an interdisciplinary conference on "Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research" held in Cleveland, Ohio, April 3 to 4, 2008. An audience of 77 clinicians and researchers attended this conference, primarily coming from Ohio and adjacent states. Articles are organized around a conceptual framework to consider primary and shared care roles of primary care physicians (PCPs) and oncologists in the care of older patients with cancer and their families. Articles in Section One focus on evidence-based clinical practice and recommendations. Section Two includes articles on original psychosocial and health services research that inform this topic. Papers in this conference were developed in recognition of the greater prevalence and growing incidence of cancer in older adults; the unique geriatric expertise and practice considerations essential to the prevention and control of cancer in older adults; the important and effective roles that PCPs may play in such care; and the need to develop shared care models that foster collaboration between PCPs and oncologists, from cancer prevention through long-term survivorship and end-of-life care of older adults. Models of shared care between oncologists and PCPs should be tested and compared for optimal care of older patients with cancer and their families. Potential implications of ideally shared care include more-informed patient-centered decision-making, better adherence to treatment, improved match between older patient goals and treatments, and thus better outcomes.

The primary care provider (PCP)‐cancer specialist relationship: A systematic review and mixed‐methods meta‐synthesis

“…A specialist‐based model entails the provision of care by cancer specialists for most issues that arise during cancer treatment and the initial posttreatment surveillance periods, including those that may fall within the scope of primary practice. However, the growing number of cancer survivors, the projected shortage of cancer specialists, and the increasing complexity of patients with respect to age and comorbidities all challenge assumptions about the effectiveness of a specialist‐based model as optimal for value, quality, and coordinated care . A fundamental component of any of these models of care and the PCP‐specialist relationship is communication, and the frequency, quality, and ideal means of communication between PCPs and cancer specialists is poorly understood.…”

“…However, the growing number of cancer survivors, 9 the projected shortage of cancer specialists, 10 and the increasing complexity of patients with respect to age and comorbidities all challenge assumptions about the effectiveness of a specialist-based model as optimal for value, quality, and coordinated care. 11,12 A fundamental component of any of these models of care and the PCP-specialist relationship is communication, and the frequency, quality, and ideal means of communication between PCPs and cancer specialists is poorly understood.…”

Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care

“…While these statistics clearly indicate the need for geriatric considerations in caring for most cancer patients, the situation is magnified by expansion of the elderly population such that in the USA, the number of patients older than 65 is expected to increase from 35 million in 2000 to 88.5 million by 2050, at which time many of these patients will be older than age 85 years [5,6]. In fact, based on the anticipated increase in the number of older individuals with cancer and the expansion of the population over 65 [7], plans are already underway to prepare for an ‘epidemic of cancer in the aging population’ [8]. …”

The Role of Primary Care Physicians in Advanced Cancer Care: Perspectives of Older Patients and Their Oncologists

“…PCP and oncologist collaboration may be especially important in advanced cancer care for older patients, a particularly challenging context for medical care. 1 The ways in which patients and oncologists think about the role of the PCP in cancer care are relevant in understanding how care is and should be delivered. The level of the PCP's involvement in care may be related to various patient characteristics and to oncologists' attitudes.…”