Background
Older people have co-morbidities and impairments contributing to higher risks of cancer treatment complications and poorer quality of life[i]. In 2023, 47% of Monash Health patients aged ≥ 65 years receiving systemic therapy for GI (gastrointestinal) cancer presented to emergency departments (ED). The FIT (Frailty Informed Treatment) project aimed to capture the vulnerability of older patients, inform treatment decisions and improve supportive care and outcomes within the constraints of stretched resources.
Methods
This quality improvement pilot ran over 10 months, utilising ASCO’s Practical Geriatric Assessment (PGA) for newly diagnosed GI cancer patients aged ≥ 65 years considered for systemic therapy. Prior to the first oncology visit, medical notes and PGA results were discussed at a weekly multidisciplinary meeting (MDM) comprising a geriatric oncologist, geriatrician, nurse practitioner and nurse navigator. Geriatric oncology MDM recommendations were clearly labelled in the medical record. Outcome measures included vulnerabilities identified and treatment related complications (from treatment commencement up to 12 weeks). A retrospective cohort of patients ≥ 65 years receiving treatment in 2023 (usual care) was used for comparison.
Results
64 PGAs were completed. Of 39 patients prescribed treatment, 90% were discussed at an MDM with 79 referrals generated to supportive care services and allied health.
FIT showed increased supportive care screens (30 compared to 25) and early referrals generated (79 compared to 44). Whilst treatment dose reductions, delays and cessations were similar in both, greater unplanned admissions (14 compared to 11) and length of stay (14 days compared to 9 days) emerged in the usual care group.
Conclusion
Geriatric assessment provides valuable information about domains typically neglected in routine practice. Results equip cancer professionals with the ability to tailor treatment and supportive care referrals to elderly patients. Identifying vulnerabilities is crucial to accessing safe, high-quality patient-centred health care and limiting treatment complications.