Geriatric Oncology: Why older patients need a special approach

Anthea Cree is a clinical oncologist currently undertaking an MD in advanced radiotherapy at The Christie NHS Foundation Trust. She co-founded a group within the hospital to work towards better outcomes and experience for older patients.

I recently did a clinic during which the average age of the patients was over eighty and the oldest nearer to one hundred. This is probably not unusual for the readers of this blog but I’m an oncologist, not a geriatrician.

I’ve been an oncology registrar for six years and even over this short period of time, it seems like encountering octogenarians in clinic has changed from unusual to routine. This is a positive step as a third of cancer patients are over 75 years old and in the past many did not get a chance to see a specialist as they were automatically deemed to be too old for treatment.

Oncogeriatrics, gaining momentum!

Dr Kirsty Colquhoun has been a consultant geriatrician, working in Glasgow, since August 2015. She works across a variety of hospitals, including Glasgow Royal Infirmary, Gartnaval General hospital and The Beatson. In addition she works with Macmillan, developing oncogeriatric services. In this blog she discusses the BGS Oncogeriatrics Conference on 7 December 2017 at the Wellcome Collection in London. She tweets @colki1983

Oncogeriatrics…it is a relatively new speciality but those of us involved in it can see it is an exciting one, gaining momentum. The BGS Oncogeriatric SIG was inaugurated in 2015, and our annual meeting this year is on the 7 Dec 2017.

Particularly since the Cancer Services Coming of Age Report there has been increasing recognition that the way in which we manage our older patients with cancer, could, and should be improved and tailored to their specific needs. The benefits of CGA extend to cancer care, with outcomes and tolerance of treatment improving with its use.

Book Review: Problem Solving in Older Cancer Patients

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.

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.

Sixty 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.

Improving cancer care for older people

Dr Shane O’Hanlon is a consultant geriatrician with the Macmillan COCOC team (Comprehensive Care for Older People with Cancer) at the Royal Berkshire NHS Foundation Trust. He tweets @drohanlon

Today is World Cancer Day, and is a good opportunity to take stock of where we are with cancer care for older people.

Many people are surprised to hear that the majority of cancers are now diagnosed in people over the age of 65 years – this group is 11 times more likely to develop cancer than young adults. The incidence of cancer generally has been increasing since the 1970s, but the largest increase has been among people aged 75 years and older.

So we really should be offering excellent care to this group, and outcomes should be constantly improving. Is that what is happening?

BGS Oncology SIG Meeting Report

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.

@profseanduffy explains that one third of cancer diagnoses now in >75s and half of death #bgsconf #gerionc http://t.co/llNcTY04i7—
BritishGeriatricsSoc (@GeriSoc) September 18, 2015

On Friday the 18^th 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.

Tailored care for older patients with cancer in Latin America: an imminent challenge

Enrique Soto Pérez-de-Celis and Ana Patricia Navarrete-Reyes work at the National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City. They tweet at @EnriqueSoto8 and @patsnavarrete

Although cancer can affect any person, regardless of their age, most people with cancer and most cancer survivors are older adults. Cancer is a disease of ageing, and in an ageing world, the role of the geriatrician in the management of the older adult with cancer is progressively becoming more and more relevant.