Assessing the Unique Needs of Geriatric Patients with Cancer

A recent ACCC survey of its membership asked cancer practices and programs how often they assessed the unique needs of their older adult patients. Nearly half reported having limited familiarity with current geriatric assessment tools. Seventy-four percent said they do not use screening tools to identify older adult patients with additional needs. Given that experts predict that by 2030, 70 percent of cancers will be diagnosed in older adults, these numbers are worrying.¹

Oncologists know that older adult patients do not necessarily respond in the same way to the treatment protocols most often used for younger patients. Delivering optimal care to this patient segment requires assessment of multiple functional domains, specialized knowledge of how cancer may affect older bodies, and a specific set of tools with which to determine the best treatment options. Each team member contributes to this process, which was the focus of the second installment of a six-part webinar series for the ACCC education program, Multidisciplinary Approaches to Caring for Geriatric Patients With Cancer.

On April 22, Melissa Loh, MBBCh, BAO, a geriatric hematology/oncology fellow at the University of Rochester Medical Center in New York, presented on, “What Every Cancer Program Team Member Needs to Know About Geriatric Assessment.” Loh said that within the past decade, an increasing amount of research has supported the usefulness of geriatric assessment and screening tools in caring for older patients with cancer. A variety of validated, easy-to-use tools now exist that are not costly, time-consuming, or onerous.

Loh explained that geriatric assessments and screenings serve as multidisciplinary diagnostic tools that can detect potentially problematic issues in older adult patients that may not otherwise surface during routine patient evaluations. The issues targeted by these assessments fall into seven domains that are independently associated with patient morbidity and mortality:

• Functional status
• Psychological health
• Nutritional status/BMI
• Comorbidity
• Cognitive status
• Social Support
• Medications

While there are a number of geriatric assessment and screening tools available, Loh explained that which one you use is not as important as ensuring that each of the seven domains are adequately assessed. The benefits of assessing older patients are significant. Patient answers combined with information from tools, such as chemo toxicity calculators, can help providers predict potential for surgical complications and chemotherapy toxicities, modify patient treatment/chemotherapy according to individual needs, better prepare for shared decision-making discussions on goals of care, and communicate effectively about age-related concerns.

Regardless of a cancer program or practice’s resources, Loh said that geriatric assessments or screenings are something staff can work into even very busy clinic schedules. Contrary to prevailing thought, geriatric assessments are not time-consuming. Most comprehensive evaluations take 15 minutes to 30 minutes to complete. Many can be completed by patients at home or prior to the clinic visit, for example, answering questions concerning functional status, nutrition, social support, and psychological health. If assessments are a joint effort of all patient-facing staff, by the time patients see their oncologist, the clinician will have all of the information necessary to focus on an individual patient’s specific needs.

ACCC lists on its website a variety of geriatric assessment and screening tools from which cancer programs and practices, large and small, can chose. Join us on Monday, May 6, for the next webinar in ACCC’s series: “Time for a reMEDy: A Focus on Pharmacy and the Older Adult.”  Future webinars can be found here. All webinars require registration and are free of charge.

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1. Smith BD, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758-2765.