Researchers at Thomas Jefferson University’s Kimmel Cancer Center have developed a model for the establishment of a comprehensive multidisciplinary geriatric oncology center to help combat the over or under treatment that elderly oncology patients often face. The model is aimed towards both newly diagnosed and established patients aged 70 and over.
It’s an important aspect of delivering cancer care, especially because the US population over the age of 65 is expected to double in size by 2030, and the cancer incidence is 11 fold higher in this age group. About 60% of all cancers and 70% of all cancer mortalities occur in people over 65 years of age.1
Professionals in medical oncology, geriatric medicine, pharmacy, social work, and nutrition evaluated patients during a two-hour visit. After the visit, the inter-professional team meets to review each case and formulate a comprehensive treatment plan. Afterwards, the patient is classified as fit, vulnerable, or frail based on the Comprehensive Geriatric Assessment (CGA).
The CGA is an important tool that can be used to improve outcomes. However, formulating the best model for a CGA has yet to be determined. Current models involve a frailty screening, followed by referral for additional assessment if the patient is determined to be vulnerable or frail.
Lead researcher, Andrew E. Chapman, DO, clinical associate professor of Medicine at Thomas Jefferson University, and co-director of the Jefferson Senior Adult Oncology Center, identified several challenges in developing the clinic, including patient-related issues, navigation, financial reimbursement, referral patterns, and coordination of care during office hours.
A total of 211 patients were initially treated when the unit opened. The average age of the patient seen was 80.7 and the most common diagnoses was breast, colorectal, and lung cancers. Twenty-four percent of patients were determined to be fit, 47% were vulnerable, and 29% frail.
Helping patients navigate the healthcare system to make appointments, obtain records, and confirm locations led to high compliance and satisfaction for the patient and family members.
Next steps for the center include the development of a clinical trials program and the continuing training of fellows in both medical oncology and geriatrics to enable dually boarded, fully certified geriatric oncologists.
1. Yanick R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer—Am Cancer Soc.
Chapman AE, Swartz K, Schoppe J, Arenson C. Development of a comprehensive multidisciplinary geriatric oncology center, the Thomas Jefferson University experience. J Ger Onc. 2014;5:164-170.