In 2008, the Institute of Medicine (now the National Academies of Science, Medicine, and Engineering) released its influential report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, which called attention to the importance of the psychosocial needs of cancer patients and the consequences of these needs remaining unmet. The IOM report concludes:
Attending to psychosocial needs should be an integral part of quality cancer care. All components of the health care system that are involved in cancer care should explicitly incorporate attention to psychosocial needs.
Today, there is an increasing body of knowledge around this area, and organizations like the Commission on Cancer (CoC) and others are including distress screening as part of their guidelines and accreditation standards.
ACCC, along with its project partner APOS, identified three ACCC member programs that are serving as model sites for the “Psychosocial Distress Screening” project.
Spoiler Alert: If you missed this week’s ACCC webinar on “A Review of Validated Tools for Geriatric Assessment and How to Use Them,” this blog post starts with the bottom line takeaway.
Presenter Tanya M. Wildes, MD, cut to the chase in concluding Monday’s webinar: “Let’s agree to stop saying that it [geriatric assessment] is time-consuming!”
Contrary to popular belief, she said, assessments for elderly patients with cancer, do not consume much of a provider’s time. Feasibility studies indicate that an abbreviated geriatric assessment takes about 20 to 25 minutes, of which only 4 to 6 minutes require a provider’s time. Those few minutes are time well-spent, said Dr. Wildes, considering the excessive time providers may have to spend on managing adverse events for older patients who would have responded better to a treatment plan modified for their specific needs. Dr. Wildes is Associate Professor of Medicine at Washington University School of Medicine in St. Louis, Missouri. During the May 13 webinar, she reviewed the development, validation, and utility of the most commonly used geriatric assessment tools.
For the webinar, Dr. Wildes described the differences between geriatric screening tools and geriatric assessments. Both can be used to improve care for senior adult patients. Screening tools can be used to determine whether a patient should be referred for further evaluation; geriatric assessment tools can be used to capture a more comprehensive view of the elderly patient across multiple domains both to refer for needed support services and to determine a patient’s risk for specific negative outcomes.
For elderly patients with cancer, a comprehensive geriatric assessment (GCA) takes into account a series of patient-specific variables—including cognition, function, communication, comorbidities, medications (polypharmacy), social support (both environmental and socioeconomic)—together with toxicity risk calculator tools—to arrive at a risk prediction for potential negative treatment outcomes such as chemotherapy toxicity and early mortality. With this information, said Dr. Wildes, oncologists can more effectively modify cancer treatments and the care team can better understand and address the patient’s supportive care needs.
Dr. Wilde discussed some of the most commonly used validated assessment tools and reviewed current research on their efficacy. Among the most frequently utilized are the CARG Chemo Toxicity Calculator (from the Cancer and Aging Research Group), the CRASH Score Calculator (Chemotherapy Risk Assessment for High Age Patients from the Moffitt Cancer Center), and ePprognosis, an online tool from the University of California San Francisco. Each of these assessments, noted Dr. Wildes, have their respective strengths and weaknesses. Visit the ACCC website for a comprehensive list of geriatric oncology screening and assessment tools and resources.
To address the utility of assessments, Dr. Wildes reviewed a series of published studies that have evaluated the extent to which oncologists modify individual treatment regimens in response to the results of geriatric patient assessments. Among the findings is evidence that providing an oncologist with the results of a senior adult patient’s assessment increases modifications for age-related concerns and improves patient satisfaction with provider communication.
If you missed Dr. Wildes’ webinar or any webinars in ACCC’s series on multidisciplinary approaches to caring for geriatric patients with cancer, you can view them on demand. Join us for the next webinar in the series—Empowering the Multidisciplinary Team to Support Care for Geriatric Oncology Patients—on Tuesday, May 21. All webinars require registration and are free of charge.