Dr Shane O’Hanlon is a consultant geriatrician with a special interest in surgical liaison and cancer care for older people. He tweets @drohanlon
As geriatricians seem ever thinly spread, the possibility of us providing input to the population of older people with cancer seems challenging – especially when you consider that a majority of cancer diagnoses and deaths occur in the over 65s. However oncogeriatrics has taken root in the past 2 or 3 years and there are now a few centres nationally offering just this approach. For those geriatricians who are hoping to provide it (or oncologists who are trying to entice them) this book will be of great interest.
“Problem solving in older cancer patients” is published in association with the Association of Cancer Physicians (ACP), and also the British Geriatrics Society (BGS) (but this of course does not affect the objectivity of this review!). It represents a great team effort by a range of geriatricians and oncologists, including trainees.The book is structured in two sections: approximately 100 pages of teaching about the area and around 200 pages of cases. For me, this balance really makes sense – the best learning is to be had by going through the cases. The initial section covers topics such as CGA, drug therapy, screening and epidemiology. It also examines the special needs of older people in terms of undertaking chemotherapy, radiotherapy and surgery. Each of these chapters is brief enough to get through quickly, but written with just enough detail to be helpful. We also get a perspective from nurses, AHPs, anaesthetist, surgeon, GP and palliative care specialist.
The book really comes into its own once you dip into the cases. These are all co-written by geriatricians and oncologists, ensuring both sides are dealt with properly. They are clearly based on real-life cases that have been well chosen and offer a rich perspective into the complicated treatment pathways that need to be considered. Pragmatism abounds and we can see that the geriatrician’s input really adds to the oncology management.
What can be improved? The book targets oncologists, geriatricians, nurse specialists and GPs and is reflected by the book being published in association with UK societies for cancer (ACP) and geriatrics (BGS). Although just over a third of cases include learning related to surgery, the book more focuses on non-surgical treatments and on the interactions between these treatments, side effects and common comorbidities and geriatric syndromes as well as quality of life issues. I’d like to see more input from surgeons as this is very often the initial management of cancer – geriatricians should be involved from this early stage. It would be useful to know more about the surgical procedures used and the difference in their risks as this feeds into the management options along with oncological treatment. I also hoped more attention would be given to polypharmacy specific to cancer patients as this can be very complex and is an area I have not seen much guidance on.
Overall how useful the book will be depends on where you are coming from. Clearly it’s for quite a specific audience but jobbing generalists would also benefit from some knowledge of the area. Oncologists will love the excellent CGA chapter, and the insight gained from reading the geriatric approach in the cases. Geriatricians will be glad to learn how chemoradiotherapy affects older people, and will benefit from seeing how the CGA needs to be tailored to identify needs specific to cancer or the treatments. For those journeying into an emerging area, this book will be a great companion.