Why are we still not involving geriatricians in caring for our older cancer patients?

Dr. Fatou Farima Bagayogo is as a post-doctoral fellow who is currently interested in the organizational and professional factors that influence cancer care. This Fall, she is joining York University’s School of Health Policy and Management as an Assistant Professor in health management and global health. Some of her work is listed here. In her recent co-authored paper, she discusses creation in a hospital of a geriatric oncology clinic whose mandate is to facilitate the inclusion of geriatrics-based expertise in the care of older cancer patients.

aaSixty percent of new cancers are diagnosed in patients older than 65 years of age. Given the vulnerabilities of older cancer patients, cancer specialists increasingly need the inclusion of some geriatric competence in managing these patients. Geriatricians can help them with a better assessment of a patient’s condition and a more adapted handling of these patients’ vulnerabilities. Considering the ageing of the population and the fact that cancer care will have to be increasingly adapted to the age group that will make the bulk of cancer patients, we studied whether or not this adaptation is taking place and the associated reasons. We tried to identify and explain the patterns of referrals from cancer specialists to a clinic staffed by geriatricians who are interested in being involved with older cancer patient care. These referrals are a good indicator of the extent to which practices can change in cancer care to better care for older, more fragile patients including those with multi-morbidity and other vulnerabilities. The data for this study is collected using semi-structured interviews from physicians and nurses as well as document analysis.

Our study opens the “black box” of collaboration between two important groups of professionals who can complement each other in caring for older cancer patients. We found that there is a significant influence of specialty on cancer specialists’ referrals to geriatricians. In the hospital that we studied, we found that surgeons were more inclined to collaborate with geriatricians than medical oncologists. The surgeons found the geriatricians’ assessment more useful in facilitating treatment decision making for their patients. In contrast, the medical oncologists considered that the geriatricians’ services provided little value added for patient care. They explained that one of the reasons for this limited value added is the lack of trial-backed evidence to support the recommendations and interventions of geriatricians.

Our findings suggest at least two ways to improve the integration of oncology and geriatric medicine. One of them is for geriatricians to tailor their services to the different specialties of cancer treatment. The basis of the collaborative ties that they build with surgeons and radiation oncologists may have to differ from those with medical oncologists. That is to say, they may profit from defining their legitimacy and interventions on different premises depending on the cancer specialty that they cater to. Also, a potential strategy for geriatricians to carve themselves a place in cancer care is to focus their –“often limited”- resources on promoting and tailoring their services to surgeons and radiation oncologists.

View her Age & Ageing Paper here Factors influencing cancer specialists’ decision to collaborate with geriatricians in treating older cancer patients

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