Communicating with geriatric patients

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Published: 15 Nov 2017
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Prof Karis Kin‐Fong Cheng - NUS Yong Loo Lin School of Medicine, Singapore

Prof Cheng talks to ecancer at SIOG 2017 in Warsaw about assessment and communication of risks with patients in daily practice.

Prof Cheng highlights the importance of charity groups and patient advocacy circles. 

She also highlights the importance of understanding more than just the biological age stratification, as there are many factors to take into account when making a geriatric assessment. 

Her take home message is to put the patient at the centre of these assessments, and communication is key. 

This service has been kindly supported by an unrestricted grant from Janssen Oncology.

 

The talk this morning, today, was about how can we get the message of toxicity management across. Actually it’s a very important topic because in our daily oncology practice we need to communicate well with the patients about the possible benefits and possible burden, the toxicity. Then in order to have the patient understand about what is going on and then how can we make the best treatments for the patient. But of course we have a lot of gaps in terms of the communication skills and also the content so this morning I tried to put out the state of the art knowledge in this area and then to make the audience understand the best practice approaching communications and then what we need to really pay attention to when we communicate with, in particular, elderly cancer patients.

Was there much involvement from charities or patient advocacy groups?

Yes, of course. Actually this is a very important source of support. Because for the elderly cancer patient, once they get their cancer treatment done, they have to talk about going back to the community. So the professional groups, charity groups, it’s a really, really important resource to help them cope with late side effects and also talking about the survivorship rehabilitation. So that’s really one of the important teams. Also the group for these people in this oncology setting.

Do you find big differences between the ages of 65, 75 and 85 ?

Definitely there are differences but really general, really superficial. We used to be based on talking about the increment of age associated with functional ability, cognitive ability, the tolerance but the research has taught us actually that’s not really the case. Actually in particular for the geriatric specific setting we definitely need to consider the geriatric assessment, the information provided to us from them. Then this G8 by the scientific data tells us even more accurately, more reliable. We can understand about where and also what condition that the patient is, instead of just only the biological age. This morning in our talk we addressed for some patients maybe they are older than 85 but maybe they are better to tolerate, to adjust OK to the toxicity, whereas for those maybe younger, 65, but maybe they have a lot of morbidity, a lot of geriatric assessment issues. So maybe they are more high risk for the toxicity or maybe they have a poor tolerance of the cancer treatment. So definitely we need to look at the really specific geriatric parameters in the oncology setting instead of just only the biological age.

How should clinicians go forward and alter their practice with this information?

The bottom line we should be talking about is the individualism and also the scientific basis of our practices. So because we know so well the G8 tells us about the patient, talking about the baseline, the status, it will tell us about the patient function or quality and also the tolerance of the cancer treatment. Also socially the social demographic, maybe the patients have different social demographics - for them to address the treatment, address the survivorship will be different. Then talking about the clinician, practician and also the healthcare professional, for us for our daily practice we need to make individual assessment. We need to make individual consideration but what we do, our best practice has to be on strong evidence or maybe based on that, maybe more robust clinical guidelines. So we don’t have to start talking about one for all, treatment approved for everyone. Assessments are really, really crucial in the geriatric oncology setting.

What’s the take home message from your talk?

Really the take home message from my talk is talking about really putting the health of the patient at the centre of our daily practices. Of course as a clinician, healthcare professional, we have a very, very strong oncology knowledge. Then we get used to it, we’re talking about the gold standard, just like we look for mortality, benefit with toxicity. But for the patient what they maybe really value, their interests, real concern, is about quality of life. Therefore the elderly maybe there’s a more simple language for them to understand about the potential consequences and outcome for the treatment. So the key message is we need to really communicate well to these patients in the context of the language and then in particular to really take into account their health literacy levels and also their preference and also their interest. Then, most importantly, really to make sure our messages being communicated to the patient have to be understandable, have to be comprehensible by this group of patients. So throughout this communication and then eventually both patient and also the clinical side can really start talking about shared decision making. Then at the end afterwards we have a better treatment decision for the patient. So the main bottom line is the communication but the communication has to be in context, has to make sense to our elderly cancer patients. They are a very unique group of people.