Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

FIRSTCARE - Implementing ePROM-based frailty assessment for older adults into routine care at a metropolitan cancer centre in Australia (145983)

Thilo Schuler 1 2 , Kelly Elsner 1 , Jacqueline Chang 1 , Phichada Kruaval 1 , Sam Baillie 1 , Paula Macleod 1 , Sophie Norton 1 , Meredith Oatley 1 , Madeleine Tilley 1 , Rowena Broadbent 1 , Sarah Hilmer 3 , Christopher Ward 1 4 , Sarah Bergamin 1 4 , Alexander Guminski 1 4
  1. Northern Sydney Cancer Centre, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
  2. Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
  3. Kolling Institute of Research, Northern Sydney Local Health District and The University of Sydney, St Leonards, NSW, Australia
  4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

Background: Randomised trials demonstrate geriatric assessment (GA) improves outcomes for older adults with cancer. GA implementation challenges include resource constraints and the complexity of cancer care. The 2023 ASCO guideline explicitly endorses electronic patient-reported outcome measure (ePROM)-based GA to address globally limited geriatrician access for gold-standard comprehensive GA. FIRSTCARE embeds ePROM-based GA into routine care for oncology patients aged ≥65 years.  

Methods: Regular meetings engaged clinical champions: one doctor each from medical oncology, radiation oncology and haematology, and the clinical nurse consultant/nurse practitioner (CNC/NP) responsible for each of the five targeted tumour streams. REDCap-based implementation of the evidence-based CARE-GA tool was tailored to local workflows. CNC/NPs discretionarily nominated new patients or those facing anti-cancer treatment changes. Patients (occasionally with family assistance) completed the electronic GA at home; responses were auto-scored (overall frailty and subdomains) and displayed in colour-coded GA Summaries uploaded to the oncology information system (OIS).  

Results: In a staged roll-out from March-August 2026, 94 patients (median age 77 years, range 65–100) were invited; 76% (71/94) responded, with median completion time 19 minutes (IQR 15–28). Of these, 48% scored robust, 32% pre-frail and 20% frail. GA Summary feedback was completed by CNC/NPs and medical staff for 92% and 52% of patient assessments, respectively. Medical staff reported the GA Summary would inform anti-cancer treatment prescribing for 79% of patients and supportive management for 82%; CNC/NPs reported it would inform supportive management for 80%. 

Conclusions: An ePROM-based, locally tailored pathway that systematically quantifies frailty and vulnerabilities was considered feasible and valuable to personalise treatment decisions and supportive management. In line with existing workflows, medical staff preferred accessing GA summaries via the OIS, otherwise relying on CNC/NPs for escalation. Expansion towards universal screening (all ≥65-year-olds) is ongoing. FIRSTCARE demonstrates a scalable geriatric frailty assessment model closing the guideline-to-practice implementation gap.