Research in older populations with cancer shows that geriatric screening, assessment and intervention can reduce chemotherapy toxicities, hospitalisations, and emergency department (ED) presentations, increase treatment completion and improve quality of life.
Objective: This study sought to evaluate outcomes following the implementation of a nurse-led model of care in geriatric oncology.
Setting and sample: Participants included in this analysis were older patients (≥ 65 years or ≥ 50 years for Aboriginal and Torres Strait Islander people) diagnosed with lung cancer undergoing radiation or systemic therapy.
Methods: This is a quantitative comparative study that compares outcomes from a nurse-led mode of care to historical controls. The primary outcomes measured were the incidence of hospitalisations, ED presentation and the incidence of grade 3+ toxicity up to 3 months post-treatment. A group of patients treated in 2019, prior to the COVID era, were chosen as historical controls for comparison. Descriptive statistics were used to summarise data. Comparisons of hospitalisations, ED presentations and grade 3+ toxicities between cohorts were conducted using Pearson's chi-square tests and the Mann-Whitney U test. Statistical significance was defined as p <0.05.
Results: A total of 172 participants (88 NL-GOMOC and 84 historical control) were included. There was a significant reduction in unplanned hospitalisations (29 (33%) vs 46 (55%), p = 0.004). Similar positive outcomes were seen in ED presentations (p = 0.016) in the NL-GOMOC cohort compared to historical controls. There were significantly fewer systemic grade 3+ toxicities in the NL-GOMOC cohort (13 (21.0%) vs 21 (42.9%), p = 0.013) but no significant differences in local grade 3+ toxicities (p = 0.712).
Conclusion: A nurse-led geriatric oncology model utilising validated assessments and a clear referral pathway can lead to improved outcomes. Nurse-led models of care are an appropriate strategy to address Australia's ageing-related cancer healthcare challenges.