Challenges and pitfalls: practical aspects of multidisciplinary care in adults
Dr Theodora Karnakis - University of São Paulo, São Paulo, Brazil
We are hearing a lot about multidisciplinary care and implementing this practically in patients who are older who have cancer. You’re presenting on this and you talk about the challenges and the pitfalls, briefly what are the challenges and the pitfalls of looking after older patients?
There are a lot of challenges and pitfalls to implement a multidisciplinary team in geriatric oncology. That’s why we are dealing with different people from different areas with different expectations. This is a hard task and this is our challenge, to deal with these expectations and try to find a common language to achieve a common goal for our patients.
What sort of things can go wrong?
The communications, we must establish good communications between geriatricians, between the oncologists, between the patients and our geriatric team, the pharmacists, the nurses and everybody. The communication is the key about your team, the welding of your team.
You’ve done a study on this, you looked at breast cancer in older patients, what did you do?
I provided a longitudinal evaluation in patients, in elderly patients with breast cancer. Five CGA geriatric evaluations were done in two years and we wanted to see if the oncological treatment, the plan of the oncological treatment, changed. In our study 45% of the plans changed of these patients and the care, the longitudinal care, was very important to this change.
So you did comprehensive geriatric assessments more than once, you repeated it, and you changed. What kinds of things did you change as a result of those, the evolving results of your CGA?
Yes, we changed some patients who must receive chemotherapy we changed and the adjuvant was not done. Sometimes we have patients who have Downs Syndrome and they realised that we can’t do nothing about these patients so we implemented the treatment and we agreed with the oncologists that, no, we must do the treatment. We guarantee the quality of life of these patients and sometimes the oncologist or the surgeon thinks that the patient could not receive the treatment and we recommended that, no, she can receive the treatment, she will be able to tolerate this treatment and this will be best for her in quality of life, in terms of quality of life, and in other kinds of patients chemotherapy was not done. Older patients who deserved to receive surgical treatment, they received the treatment, there is no change in these but chemotherapy, hormonal therapy changed and the radiotherapy changed too.
So you can improve quality of life, then, by not giving some of the treatments which would have been given. How big was that improvement in quality of life?
We have 45% of patients we changed the treatment and we didn’t evaluate the quality of life properly. But we have 90% of patients have some kind of geriatric changes in this longitudinal care, geriatric interventions, who improved their quality of life.
What are the practical implications of this for doctors caring for their patients?
I realise that the importance of communication between the team and for comprehensive geriatric assessments make a good job, what they propose to do. We must communicate and not just do the questionnaires and not have an arguing and discussing what we are caring about our patients. We must talk about all the time with the team and with the oncologists and the surgeon. This is what is the most important thing to improve the quality of life of this care.
So you’re saying that it’s necessary to do comprehensive geriatric assessment and to repeat it.
Yes, I really think that it is important to repeat it, not just one time. We started to do this comprehensive geriatric assessment when the patient was diagnosed with the cancer and we did the first evaluation. So along with the treatment we repeat to see what is going on with these patients and this is very important, not just at the first time. Seeing these patients, providing longitudinal care and getting interventions which benefit the treatment and the patients.