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Utilisation of geriatric assessment in oncology - a survey of Australian medical oncologists

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Abstract

Introduction

Geriatric assessment (GA) is a multidimensional health assessment of the older person to evaluate their physical and cognitive function, comorbidities, nutrition, medications, psychological state, and social supports. GA may help oncologists optimise care for older patients with cancer. The aim of this study was to explore the views of Australian medical oncologists regarding the incorporation of geriatric screening tools, GA and collaboration with geriatricians into routine clinical practice.

Methods

Members of the Medical Oncology Group of Australia were invited to complete an online survey that evaluated respondent demographics, practice characteristics, treatment decision-making factors, use of GA, and access to geriatricians.

Results

Sixty-nine respondents identified comorbidities, polypharmacy, and poor functional status as the most frequent challenges in caring for older patients with cancer. Physical function, social supports and nutrition were the most frequent factors influencing treatment decision-making. The majority of respondents perceived value in GA and geriatrician review, although access was a barrier for referral. Such services would need to be responsive, providing reports within two weeks for the majority of respondents.

Conclusion

Despite an emerging evidence base for the potential benefits of GA and collaboration with geriatricians, medical oncologists reported a lack of access but a desire to engage with these services.

Introduction

A growing number of older adults in Australia are being diagnosed with cancer. This is due to a combination of an aging population and increased cancer incidence with age. A detailed assessment of the older person's health status can guide the appraisal of risks and benefits of cancer treatment, influence treatment choice and intensity and guide supportive care interventions. Assessment of physical and cognitive function, comorbid medical conditions, nutrition, medication usage, psychological state, and social supports comprise the core domains of geriatric assessment (GA).

Internationally, an increasing number of cancer services have adopted systematic approaches to the care of older adults with cancer by incorporating GA and geriatric expertise into assessment and decision-making processes [1]. In comparison, GA and geriatric oncology services remain confined to a small number of cancer centres in Australia [1].

Australia has a universal healthcare system for permanent residents covering medical consultations, public hospital admissions and subsidised pharmaceuticals. In 2016, there were 619 geriatricians in Australia with an average of 2.4 clinicians per 100,000 population [2]. Geriatric medicine and cancer services, although readily available within both public and private hospitals, often lack a formalised approach to collaboration. To date, there is limited information on Australian oncologists' views and experiences of geriatric oncology.

This study aimed to explore the views of Australian medical oncologists regarding the perception of, and barriers to the incorporation of geriatric screening tools, GA and collaboration with geriatricians in routine clinical practice.

Section snippets

Methods

A cross-sectional survey was developed by a multidisciplinary national expert steering group on behalf of the Clinical Oncology Society of Australia's Geriatric Oncology group, comprising medical and nursing representatives from medical oncology, geriatric medicine, and palliative care. The online survey, based on a literature review and expert opinion, comprised 30 questions covering: (i) respondent characteristics, clinical practice environment and patient population; (ii) challenges and

Results

Sixty-nine oncologists completed the survey (response rate 11%). Table 1 outlines respondent characteristics. Respondents reported older patients constituted a substantial portion of their practice, with 33% (23/69) estimating 51–75% of their patients were over 70 years, and a further 54% estimating 25–50% of patients were over 70 years. Fifty-nine percent of respondents reported an interest in geriatric oncology. Allied health services were ‘readily’ or ‘somewhat’ available for over 95%. No

Discussion

This study identified a perception that GA and/or geriatrician review would improve clinical assessment and influence decision-making amongst participating medical oncologists. These findings are similar to other international studies where the vast majority (75–95%) of cancer specialists believe GA is beneficial [[3], [4], [5], [6]].

In our study, comorbidities, polypharmacy, poor functional status and treatment toxicity were the most commonly identified challenges when caring for older

Conclusion

In this survey of medical oncologists, geriatric assessment of older patients with cancer and collaboration with geriatricians was welcomed. However, access to appropriate expertise was a substantial barrier. Furthermore, such services need to occur in a timely manner and work in close collaboration with oncologists in order to positively influence treatment decisions and outcomes.

Acknowledgements

The authors would like to thank all those who participated in the survey, the Clinical Oncology Society of Australia (COSA) for their support and the guidance of the COSA Geriatric Oncology group.

Funding

The authors report no external sources of funding for this study.

Conflict of Interest

C Steer reports personal fees from MSD, Roche and Janssen outside the submitted work, and is a member of the editorial board for the Journal of Geriatric Oncology. The other authors had no conflicts of interests to disclose.

Author Contributions

Study Concepts: T To, W Soo, H Lane, A Khattak, B Devitt, C Steer, J Phillips.

Study Design: T To, W Soo, H Lane, A Khattak, B Devitt, C Steer, J Phillips.

Data Acquisition: T To, C Steer, J Phillips.

Quality Control of Data and Algorithms: T To.

Data Analysis and Interpretation: T To, W Soo, H Lane.

Statistical Analysis: T To.

Manuscript Preparation: T To, W Soo, H Lane, A Khattak.

Manuscript Editing: T To, W Soo, H Lane, A Khattak, B Devitt, H Dhillon, A Booms, J Phillips.

Manuscript Review: T To, W

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