In my opinion geriatric oncology is all about supportive care. My other mantra is that adequate assessment yields appropriate management, not just appropriate treatment but appropriate management because that appropriate management could mean supportive care, just supportive care, for example. This is especially important in our older adults who may have more difficulties, more comorbidities, more need for enhanced supportive care. There is no better way to manage your patients appropriately than adequately assessing them first.
We know that geriatric assessment is important in all of our older adults with cancer. At the ASCO meeting this year it was presented by Supriya Mohile for the first time showing in a randomised controlled trial that geriatric assessment improves communication about age-related concerns. This was a pivotal trial. The next step will be to work out whether the interventions that you can apply, the supportive care interventions that you can apply, after that assessment make a difference and that’s a subject of ongoing clinical trials. But the first step is assessment and adequate communication about the patient’s supportive care and age-related concerns.
What organisations and groups are there to progress this important field?
There’s no doubt that SIOG is the global leader and the global organisation that is dedicated to the care and improving the care of older adults with cancer. I’m also the chair of the Geriatrics Study Group of MASCC; MASCC is the Multinational Association For Supportive Care In Cancer. I’ll be speaking today at the combined session, the MASCC/SIOG combined session, about the importance of supportive care in our older adults with cancer.
It’s my belief that we need to consider appropriate supportive care for our older adults with cancer across the continuum of cancer care. We’ll be discussing the importance of that and the importance of integration of supportive care in our older adults at this session.
How do we start to implement
There is no doubt that treating the whole patient rather than just the tumour is the way forward. Adequate assessment of the patient, often it’s best done at the first consultation but can be continuing, is extremely important to guide those supportive care interventions which may not be about the treatment. It may be the social aspects, it may be the palliative pain relief, it may be other aspects rather than the treatment and it’s vital to know before you launch into your treatment.
An example of that which is being presented at a poster at this meeting is asking about cognitive impairment. I would say that assessing your patients for cognitive impairment with a simple screening tool is very important. If you detect mild cognitive impairment, or even more severe cognitive impairment, in a patient it will alter your management and it’s important to know about that before you make some big decisions. It’s not part of standard oncology assessment or practice and the argument of organisations such as the International Society for Geriatric Oncology and MASCC is that it should be. It should be part of a geriatric assessment in all older adults. For example, as per the ASCO guidelines, all adults over the age of 65 being considered for chemotherapy should have a geriatric assessment for reasons just like that.
What would be the main questions asked?
It’s interesting you should say that, the question would be how do we do it. This problem is enormous – if you accept that most patients with cancer are over the age of 65 and we’re suggesting this should happen in all of them, how is that done? How do we integrate it into standard cancer care because I can tell you it’s currently not. It’s organisations like SIOG and MASCC that need to push for this, we need the resources, we need patient navigators, we need cancer care co-ordinators. We need to be able to integrate this into general cancer care to improve the care of all older adults with cancer, not just the people at the niche geriatric oncology units.
So the science is telling us we should do it, it’s the implementation and integration which is going to be the next step and it’s politically difficult, potentially expensive but if we do manage it it will benefit countless patients throughout the world.