The care of older cancer patients in the United Kingdom

Gomes, Fábio; Lewis, Anna; Morris, Rob; Parks, Ruth M.; Kalsi, Tania; Babic-Illamn, Gordana; Baxter, Mark; Colquhoun, K.; Rodgers, Lisa; Smith, Edward S.; Greystoke, Alastair; Bayman, N.; Cree, Anthea; Ng, Cassandra; Carino, Nicola de Liguori; Basile, Simone; Moore, J. A.; Merchant, Zoe; Swinson, Daniel; Parbhoo, Anita; Jones, Rachel K.; Davies, Eleri; Danson, Sarah; Young, Rowan D.; Morgan, Jenna; Wyld, Lynda; Corrie, Pippa; Doherty, Gary J.; Wright, Juliet; Reed, Malcolm; Ugolini, Fiammetta; Lind, Michael; Cheung, Kwok-Leung; Harari, Danielle; Simcock, Richard

doi:10.3332/ecancer.2020.1101

Cited by 14 publications

(10 citation statements)

References 27 publications

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“…A map of the current services and projects in the UK in the field of geriatric oncology was performed by Gomes et al in 2020 [ 59 ]. It concluded that although the care of cancer patients was a significant part of daily practice, routine care of these patients did not include a formal geriatric or frailty assessment/management and the use of treatment toxicity prediction tools was not standard practice.…”

Section: Challenges and Potential Solutionsmentioning

confidence: 99%

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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Section: Challenges and Potential Solutionsmentioning

confidence: 99%

Challenges in Geriatric Oncology—A Surgeon’s Perspective

Parks

Cheung

2022

Current Oncology

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“…Inpatients will likely have more rapid trajectories of disease progression, a higher symptom burden and a poorer prognosis than patients reviewed in outpatients. Work to evaluate the potential utility in guiding treatment decisions in outpatients is ongoing (Gomes et al, 2020 ).…”

Section: Limitationsmentioning

confidence: 99%

The Clinical Frailty Scale can indicate prognosis and care requirements on discharge in oncology and haemato‐oncology inpatients: A cohort study

Welford

Rafferty

Hunt

et al. 2022

European J Cancer Care

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Objectives: Routinely used performance status scales, assessing patients' suitability for cancer treatment, have limited ability to account for multimorbidity, frailty and cognition. The Clinical Frailty Scale (CFS) is a suggested alternative, but research detailing its use in oncology is limited. This study aims to evaluate if CFS is associated with prognosis and care needs on discharge in oncology inpatients.Methods: We evaluated a large, single-centre cohort study in this research. CFS was recorded for adult inpatients at a Regional Cancer Centre. The associations between CFS, age, tumour type, discharge destination and care requirements and survival were evaluated.Results and Conclusions: A total of 676 patients were included in the study. Levels of frailty were high (Median CFS 6, 81.8% scored ≥5) and CFS correlated with performance status (R = 0.13: P = 0.047). Patients who were frail (CFS ≥ 5) were less likely to be discharged home (62.9%) compared with those who were not classed as frail (86.1%) (OR 3.6 [95%CI 2.1 to 6.3]: P < 0.001). Higher CFS was significantly associated with poorer prognosis in all ages. Solid organ malignancy (hazard ratio [HR] 2.60 [95%CI 2.05-3.32]) and CFS ; P < 0.001) were independently associated with poorer survival. This study demonstrated that CFS may help predict prognosis in adult oncology inpatients of any age. This may aid informed shared decision-making in this setting. Future work should establish if routine CFS measurement can aid the appropriate prescription of systemic therapy and enable early conversations about discharge planning.

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“…A “physiological age” so derived could be factored into evidence-based cancer and treatment expectations (e.g., estimated remaining life years with cancer, without and with treatment, plus quality of life with or without treatment] to create a decisional process that is not arbitrarily distorted by age [ 68 , 69 ]. Assessing older patients with cancer in this function-based way should reduce risks of both over- and under-treatment [ 70 , 71 ].…”

Section: How Treatment Decisions Are Becoming Less Influenced By Chro...mentioning

confidence: 99%

How aging of the global population is changing oncology

Gu¹,

Lin²,

Epstein³

2021

ecancer

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Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between "physiologically older" and "physiologically younger" patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.

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The care of older cancer patients in the United Kingdom

Cited by 14 publications

References 27 publications

Challenges in Geriatric Oncology—A Surgeon’s Perspective

Challenges in Geriatric Oncology—A Surgeon’s Perspective

The Clinical Frailty Scale can indicate prognosis and care requirements on discharge in oncology and haemato‐oncology inpatients: A cohort study

How aging of the global population is changing oncology

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