Making care packages for elderly cancer patients

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Published: 22 Nov 2018
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Dr William Dale - City of Hope National Medical Center, Duarte, USA

Dr William Dale speaks to ecancer at the International Society of Geriatric Oncology 2018 conference in Amsterdam about providing care plans for elderly patients post treatment.

He discusses the issue of co-morbidities in older patients and how cancer treatments can have an exaggerated effect on these.

Dr Dale emphasises the need for care plans in elderly patients, and how adapting these for relatively specific cases may be necessary, which may be possible with the help of organisations like SIOG.

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

We had a session that described cancer patients who are older, who have completed treatment and now no longer have cancer identified and who need a care plan to go forward after their cancer diagnosis and all their treatments. These can be different for older cancer patients compared to younger cancer patients and the session focussed on the general challenges for survivorship for cancer patients and how might we adapt survivorship plans for older patients compared to younger patients.

Tell us about frailty and quality of life management.

For older cancer patients they start off with more challenges like comorbidities, functional problems, potentially cognitive issues, all of which are more prevalent in older patients. After we go through a cancer treatment of course a cure of cancer is wonderful but the treatments are quite harsh and so those treatments can have especially harsh effects on your other diseases, on your physical functioning and frailty and on your cognitive function. So we may need to do something different for older patients compared to younger patients. In some ways there’s the flip-side of longer term consequences. So younger patients we have much longer term recurrent cancers, true for older patients but not as important to have to worry about.

Can you give individual care plans or are they done on a much broader scale?

One of the challenges is that there are care plans that we give out to younger patients but there’s nothing essentially that we’ve figured out for older patients. A lot of our session was looking to the future to say how might we adopt geriatric principles, principles for older adults, and apply them to the current care plans but we still haven’t done that yet. So some simple examples of that are caregivers. So for older patients they’re going to have caregivers and into the future there can be major burdens on those caregivers that really aren’t in the guidelines in many cases for younger patients. Cognition – so if you have consequences from your treatment that results in decreased cognition that can have profound effects for people trying to live independently in the community. Even the guidelines themselves, just simple things like you’ve seen them, they’re quite long, detailed, the fonts are tiny; something with bigger fonts, things people can see, they might not be able to be electronic so make them actually usable. One of the big emphases on ours is the form itself is really not the point. We tend to focus on, ‘Do you have your care form to go home with?’ but it’s really an ongoing process. So people who start off in one place and we identify concerns then you identify the team that they need, that team can be a multidisciplinary group of people, social work, along with their doctors, nursing. Then it comes back to they start to develop new things because they’re getting older and it’s this ongoing process that was really emphasised for us.

Is this where the help of SIOG steps in?

Exactly, this is exactly the right place to find people who have enough expertise in cancer and all the cancer changing therapies that are now available and the consequences of those therapies but also with an eye towards what about the growing population of older patients, how do we adopt those principles? Maybe even we should have some thoughtful look into the future and the development of guidelines that are very much geriatric specific or focussed on older adults’ needs and their caregivers.

Will this come over the next few SIOGs?

I certainly hope so, maybe next year we’ll have a session on this for SIOG and maybe even a guideline. SIOG has got 37 new guidelines, we could put one together now for survivorship for older patients. Older adults are the majority of cancer patients so the majority of survivors actually turn out to be older adults. So as much as we’re thinking of this as adopting the standard for older adults there’s a part of me that says maybe we should do it for older adults first and then adopt it for everyone else since they’re the ones who are in the norm. I’d like us to maybe reverse the way we think about these things.