Referral of elderly cancer patients to specialists: Action proposals for general practitioners

Delva, Fleur; Soubeyran, Pierre; Rainfray, Muriel; Mathoulin‐Pélissier, Simone

doi:10.1016/j.ctrv.2012.03.010

Cited by 14 publications

(9 citation statements)

References 33 publications

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“…Other practical studies have been performed in other regions of France to assess the links between GPs and hospital oncologists. 8 , 9 Our data on medical practices are broadly consistent with previous results, notably on the importance of training. To our knowledge, no previous study has compared the decision-making criteria applied by GPs to the care of elderly cancer patients before and after corrective measures of practice.…”

Section: Discussionsupporting

confidence: 89%

“…The questionnaire was designed and developed in a multidisciplinary manner based on the results of a literature review and on existing guidelines in the field of geriatric oncology; some questionnaire items were reused from previous studies. 8 , 9 An early version of the questionnaire was tested and evaluated by a panel of liberal GPs, geriatricians of the Nancy Regional University Hospital and the Lorraine Cancerology Institute, and cancer specialists. The final version of the questionnaire comprised three sections: 1) demographics and physician qualifications; 2) the importance (not very important, somewhat important, or very important) of factors influencing the care of elderly patients, grouped into four categories of decision criteria related to the patient, disease, medical practice, and organization of care; and 3) the GPs’ perceptions of the elderly, their knowledge of oncogeriatric structures, and open-ended questions about opportunities for improvement and solutions.…”

Section: Methodsmentioning

confidence: 99%

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Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France)

Niemier¹,

Claudot²,

Nguyen-Thi³

et al. 2018

CIA

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ObjectiveThe objective of this study was to identify changes in the decision-making criteria of general practitioners (GPs) concerning the care of elderly cancer patients after 1 year of corrective measures for care practices in the Lorraine region, France.Materials and methodsIn 2014, a postal mail questionnaire was sent to all GPs in the Lorraine region. This questionnaire was designed to identify GPs’ decision-making criteria. It was based on the results of a literature review and on existing guidelines. During 1 year, corrective measures were implemented to improve practices, especially training sessions for physicians and production of specific tools, including a guide to the accepted ideas in geriatric oncology. In 2015, the same questionnaire was resent to all GPs to compare the answers.ResultsIn 2014, 430 questionnaires were returned out of 2,048 sent, and in 2015, 378 questionnaires were returned out of 2,066 sent. Our results show for the first time that there exists a significant difference in the overall decision criteria between the two survey periods. This difference mainly concerns criteria related to the cancerous diseases. Physicians tend to consider the principal decision criteria to be less important after the training period. GPs express the importance of accessibility to specialists for additional advice in both 2014 and 2015; the distance between the patient’s home and an adapted care facility and the interval before care begins are viewed as similarly important.ConclusionTraining and information sessions for physicians remain the most important tool for improving care practices. Such training strategies are more effective when carried out at the geographical scale at which the cancer professionals practice, allowing them to exploit their local organizational structure. The analysis of our data makes it possible to further integrate the patient into the care path, which remains a public health issue in terms of cost and organization.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France)

Niemier¹,

Claudot²,

Nguyen-Thi³

et al. 2018

CIA

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“…It is unclear why black women are not receiving guidelines‐based treatment; however, it is possible that difficulty in accessing particular hospitals or physicians may play a role. Geographic disparities in ovarian cancer care have been well documented,and a recent study in 1 urban NCI‐designated cancer center indicated that, the farther patients with gynecologic cancer were required to travel to get to treatment (those traveling > 10 miles but < 50 miles), the less likely they were to complete recommended care . Patient influences could be another potential reason why black women may not be receiving guidelines‐based care.…”

Section: Discussionmentioning

confidence: 99%

Disparities in ovarian cancer survival in the United States (2001‐2009): Findings from the CONCORD‐2 study

Stewart

Harewood

Matz

et al. 2017

Cancer

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BACKGROUND Ovarian cancer is the fifth leading cause of cancer death among women in the United States. This study reports ovarian cancer survival by state, race, and stage at diagnosis using data from the CONCORD-2 study, the largest and most geographically comprehensive, population-based survival study to date. METHODS Data from women diagnosed with ovarian cancer between 2001 and 2009 from 37 states, covering 80% of the US population, were used in all analyses. Survival was estimated up to 5 years and was age standardized and adjusted for background mortality (net survival) using state-specific and race-specific life tables. RESULTS Among the 172,849 ovarian cancers diagnosed between 2001 and 2009, more than one-half were diagnosed at distant stage. Five-year net survival was 39.6% between 2001 and 2003 and 41% between 2004 and 2009. Black women had consistently worse survival compared with white women (29.6% from 2001–2003 and 31.1% from 2004–2009), despite similar stage distributions. Stage-specific survival for all races combined between 2004 and 2009 was 86.4% for localized stage, 60.9% for regional stage, and 27.4% for distant stage. CONCLUSIONS The current data demonstrate a large and persistent disparity in ovarian cancer survival among black women compared with white women in most states. Clinical and public health efforts that ensure all women who are diagnosed with ovarian cancer receive appropriate, guidelines-based treatment may help to decrease these disparities. Future research that focuses on the development of new methods or modalities to detect ovarian cancer at early stages, when survival is relatively high, will likely improve overall US ovarian cancer survival.

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“…There was a high proportion of patients both > 80 years and with comorbidities or impaired KPS, IADL, or ADL. Even though there is paucity of data regarding the referral practice of older patients with cancer to specialised care (Delva et al 2012), we believe that this cohort represents a "real world" population of older patients with cancer. Characteristics of patients enrolled in the registry are similar to a previous report from a German oncology practice (Wedding et al 2007).…”

Section: Discussionmentioning

confidence: 97%

Patient assessment and feasibility of treatment in older patients with cancer: results from the IN-GHO® Registry

Honecker

Huschens

Angermund

et al. 2021

J Cancer Res Clin Oncol

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Purpose Predicting feasibility of treatment in older patients with cancer is a major clinical task. The Initiative Geriatrische Hämatologie und Onkologie (IN-GHO®) registry prospectively collected data on the comprehensive geriatric assessment (CGA), physician’s and patient’s-self assessment of fitness for treatment, and the course of treatment in patients within a treatment decision aged ≥ 70 years. Patients and methods The registry included 3169 patients from 93 centres and evaluated clinical course and treatment outcomes 2–3 and 6 months after initial assessment. Fitness for treatment was classified as fit, compromised and frail according to results of a CGA, and in addition by an experienced physician’s and by patient’s itself. Feasibility of treatment (termed IN-GHO®-FIT) was defined as a composite endpoint, including willingness to undergo the same treatment again in retrospect, no modification or unplanned termination of treatment, and no early mortality (within 90 days). Results CGA classified 30.0% as fit, 35.8% as compromised, and 34.2% as frail. Physician’s and patient’s-self assessment classified 61.8%/52.3% as fit, 34.2%/42.4% as compromised, and 3.9%/5.3%, as frail, respectively. Survival status at day 180 was available in 2072 patients, of which 625 (30.2%) had died. After 2–3 months, feasibility of treatment could be assessed in 1984 patients. 62.8% fulfilled IN-GHO®-FIT criteria. Multivariable analysis identified physician’s assessment as the single most important item regarding feasibility of treatment. Conclusion Geriatricians were involved in 2% of patients only. Classification of fitness for treatment by CGA, and physician’s or patient’s-self assessment showed marked discrepancies. For the prediction of feasibility of treatment no single item was superior to physician’s assessment. However CGA was not performed by trained geriatricians.

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Referral of elderly cancer patients to specialists: Action proposals for general practitioners

Cited by 14 publications

References 33 publications

Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France)

Improvement of decision-making criteria for the care of elderly cancer patients by general practitioners (Lorraine, France)

Disparities in ovarian cancer survival in the United States (2001‐2009): Findings from the CONCORD‐2 study

Patient assessment and feasibility of treatment in older patients with cancer: results from the IN-GHO® Registry

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