Background: The International Society of Geriatric Oncology (SIOG) was founded in the year 2000, but still – after 23 years – Australia and New Zealand are yet to establish a gold-standard approach to older adults with cancer. This is despite 60-70% of newly diagnosed cancer patients in Australia and New Zealand being over the age of 65 years, and multiple randomised controlled trials proving the benefit of CGA in older adults with cancer. In 2022, I commenced dual training in oncology and geriatric medicine, with a dream to bring our worlds together and rapidly improve this area of need through education, collaboration, and mobilisation of existing specialists/trainees to maximally optimise the care of older adults with cancer.
Change:
- Established the “Viray CGA” (V-CGATM): a cancer-specific CGA - includes: cancer history; performance status; frailty status; prognostication; chemotoxicity risk profiling; geriatric syndromes/domains (cognition, comorbidities, continence, falls and bone health status, function, mobility, medications, mood, nutrition, sensorium, social supports/services); shared decision making; and advanced care planning
- Combined Geriatric Medicine/Medical Oncology consultation for all new cancer patients
- Became “Geri-Onc liaison officer” for the hospital, receiving referrals for geriatric assessments, with education for whom to refer
- Geriatric Medicine presence at cancer multi-disciplinary meetings (MDMs)
- Education sessions to raise awareness about geriatric oncology (unit meetings; grand rounds; journal clubs; Victorian advanced trainee groups)
- Wrote a new position statement for the ANZSGM: “CGA in older adults with cancer”
Learnings:
- A major barrier is the differences between time per patient spent in geriatrics clinics versus oncology clinics (45-90mins for CGAs versus 15-30mins for oncology)
- The V-CGA can be done in as little as 30mins
- Oncologists find the V-CGA useful and can alter their patients' cancer treatment plans for the better (helps prevent over-treatment in the vulnerable/frail, and under-treatment in the objectively fit)
- Patients benefit from unknown/unmet geriatric needs being revealed and intervened
- Cancer MDMs are a key timepoint where geriatricians can affect beneficial change in the management of older adults with cancer
- There is a lack of awareness, training, and education for both oncologists and geriatricians in the nuances of comprehensive geriatric oncology assessments
- Geriatricians and oncologists must collaborate to establish pragmatic/functional models of care in whatever healthcare systems they are in
- A Geri-Onc liaison officer is a useful role to coordinate and streamline referrals
- Medicare items need to be altered to allow easier access to CGAs