Dr Lucy Dumas is a Medical Oncology Specialist trainee at the Royal Marsden. She has just started research with Dr Susana Banerjee towards an MD degree focusing on the treatment of Gynaecological cancers in older patients. Here she fills us in on what happened at the first ever BGS Oncology Special Interest Group meeting.
On Friday the 18th September, the inaugural meeting of an Oncology Special Interest Group, part of the British Geriatrics Society was held at the Wellcome Collection in London. Myself and a small group of other intrepid oncologists and surgeons from around the UK were welcomed into the world of geriatrics, with the common aim of gaining a better understanding of the current status of the growing field of “Geriatric Oncology”; how outcomes for older patients may be improved.
It is well known that cancer is a disease of increasing relevance to older adults with at least half of all new diagnoses occurring in those over the age of 65 and an increasing rate of emergency presentations (70% in the over 75s according to data presented by Sean Duffy, National Clinical Director for Cancer for NHS England) known to be associated with a later stage of diagnosis and poorer outcomes. Despite this clear need for better cancer care in the older population, the progress being made in improving outcomes is not being translated to the older population. Older patients are less likely to be recruited into clinical studies, cancer mortality rates in the UK for older patients improving at a slower rate and in those over the age of 85, actually increasing by 2%.
As a Medical Oncology trainee at a tertiary cancer centre, I spend a great deal of my working week assessing patients with a new diagnosis of cancer and those who are already going through systemic chemotherapy with either curative, adjuvant or palliative intent. Older patients with multiple medical comorbidities and/or issues with care or coping at home represent a significant challenge when it comes to evaluating whether or not they will be able to tolerate potentially toxic therapies and at present, there is a marked lack of data to support the decision-making process for older patients. The first statement of the Hippocratic oath “Do No Harm’ ever ringing in our ears, do we in fact err towards under-treatment in some cases?
The need for research and development of the field of Geriatric Oncology is clear. Sean Duffy presented thought-provoking data on patients’ attitudes to treatment. Contrary to popular belief, older patients are not more likely to decline treatment but do have a lower awareness of services available and are more reticent about seeking healthcare services. Maintaining independence is a key concern for older patients; an interesting point was raised in the subsequent discussion over whether the current endpoints of progression-free (the time from the beginning of a new treatment to progression following on from treatment) and overall survival; for clinical trials in Oncology are as appropriate in the older population.
For those who regularly treat older patients with cancer, improving our assessment and treatment of older, less fit patients is a clear, still unmet need and collaboration between geriatricians, oncologists, surgeons and allied healthcare professionals is going to be key. The pilot liaison services undertaken at Guy’s and St Thomas’ (by Dr Danielle Harari and Dr Tania Kalsi) and the Royal Berkshire Foundation NHS Trust (Professor Margot Gosney and Dr Shane O’Hanlon) provide inspiring examples of how these services can be implemented and benefit patient care.
In summarising the inaugural meeting of this special interest group, Professor David Oliver, president of the British Geriatrics Society left us all with a clear sense of the scope of the challenge ahead but also the hope that, with the Department of Health and NHS England recognizing the growing need, as well as involvement from the charitable sector, the time is ripe to push forward research and service developments to improve cancer outcomes in older patients. I’m looking forward to seeing where we’re up to this time next year!