Background
Older adults with cancer often have multimorbidity, frailty, functional impairment and complex supportive care needs that can affect treatment tolerance and decision-making. Comprehensive geriatric assessment is widely used to guide prognosis, treatment selection and person-centred interventions in older adults with cancer.
Aims
To describe the initial establishment of an older adult oncology service at the Sunshine Coast Hospital and Health Service.
Methods
A collaborative service model was developed between Oncology and Geriatric Medicine. Patients considered at risk of frailty, treatment complexity or competing comorbidity were identified for early geriatrician review, predominantly via the head and neck cancer multidisciplinary team meeting. One clinical session per week was devoted to providing timely assessment of comorbidity, cognition, function, nutrition, symptom burden, social supports and goals of care, with recommendations communicated to the treating oncology team to support treatment planning, supportive interventions and advance care planning.
Results
In the first five months of the OASIS, 31 patients were reviewed, median age 84 years (range 73-98). Median Montreal Cognitive Assessment (MoCA) score was 19/30 (range 8-27). Significant concerns for cognitive impairment were identified in 20 patients, of which twelve had a new dementia diagnosis made, four had a preexisting diagnosis and four required further longitudinal observation. The service enabled early geriatrician input (median time to review 13 days; range 1-28 days) and created a practical pathway for this complex patient group. Early experience suggests that the model is feasible and acceptable, improves access to holistic assessment, and supports more individualised treatment planning, supportive care referral and timely goals-of-care discussions.
Conclusions
Establishing an older adult oncology service is a feasible service innovation that supports frailty-informed, person-centred care for older adults with cancer. This model is scalable to other regional cancer services.