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.

G4J Connect: Bristol

Hot on the heels of evening events in Leeds and Glasgow, a team in Bristol will be running a free teaching event on behalf of the Association for Elderly Medicine Education (AEME) on 26^th March 2015. AEME tweets at @ElderlyMedEd.

This event is open to any junior doctors who look after elderly patients as part of their job, and would be particularly suitable for foundation doctors and core medical trainees. The programme consists of snappy, interactive talks on topics such as interface geriatrics and Parkinson’s disease. Towards the end, those considering pursuing a career in geriatric medicine will have the chance to address a panel of specialist trainees from across the Severn region regarding being the med reg and applications to ST3. If this last part would not be for you, you are welcome to attend the rest of the evening and leave beforehand.

Why do allied health professionals need to be empowered?

Esther Clift is a Clinical Specialist Physiotherapist in Southampton, and a BGS member. In December she attended a conference for allied health professionals at The King’s Fund, chaired by BGS President David Oliver.

Last month, The King’s Fund put on a well subscribed event entitled ‘Empowering Allied Health Professionals to Transform Health and Care Services’.

That title set me wondering: why would we need to be empowered? After all, AHPs like me already make up a significant proportion of the health and social care workforce. 172,686 of us are registered with the Health and Care Professions Council, and yet it seems we are often lumped into an amorphous group of ‘doctors and nurses’ who deliver health care.

Is that just because too few people (even those who should know better) can name more than three or four of the twelve professions under the ‘allied’ banner?  Do we have a crisis of identity?

Bones and a reflection on training opportunities

I have to admit, bones do play a key role in my life, not only do they allow me to get about, safely protecting my internal organs, balancing my calcium and providing me with a ready supply of haemopoetic cells, but bones also provide the ‘back-bone’ to my working life both as an orthogeriatrician and as an epidemiologist.

I remember when I was starting out as a SpR in geriatrics; I had that feeling of wanting to ‘do some research’, but was in that all too common position of wondering ‘where do I start’? That year a course was advertised in the BGS newsletter ‘Osteoporosis and other metabolic bone diseases’. I was just beginning to develop an interest in orthogeriatric medicine and this residential course, run at one of the Oxford colleges and specifically aimed at trainees, offered a comprehensive overview of osteoporosis biology, treatments, monitoring, and radiology, as well as topics such as renal osteodystrophy, primary hyperparathyroidism and Paget’s disease. It proved a really educationally valuable few days and the course manual provided an excellent reference resource for a number of years.

The Regs’ Review:- POPS Course- Guys and St Thomas’ Hospital- March 2012

Overview
A 2 day course covering all aspects of pre-operative issues concerning the older surgical patient. Organised intermittently throughout the year in London(with proper planning can make for a productive long weekend in the capital).

Target Audience
Consultants, Registrars (excellent for the pre-operative bits on the curriculum) , Specialist Nurses and other health professionals involved with surgery and the older patient

Review
An excellent and thought-provoking course which features a diversity of speakers and covers a broad remit of pre-operative issues specific to older patients. From hypertension to cardiac status; high blood sugars to low HB the course tries to answer majority of plausible clinical scenarios that may be encountered in day-to-day clinical practice. Ortho-geriatrics is also featured during the 2 days and as a bonus there are also excellent talks and insights regarding the highs and lows of setting up a new service.

The local Pre-operative service [set-up and championed by Guys and St.Thomas hospital] is also introduced to the audience. The service is highly comprehensive covering both the Pre-operative and Post-operative journey of the older patient. Patients do seem to be managed better and there is greater integration between surgeons and geriatricians.

Overall, this is an excellent course which will leave you better off for having attended.

Value for money:
Priceless as it is the only one of its kind so far.