• Aristotle
• ethos
• logos
• nursing editorials
• pathos
• persuasive discourse

The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.

• United Kingdom
• cancer
• geriatric oncology
• older patients

• Aged
• Aged, 80 and over
• Caregivers
• Evaluation Studies as Topic
• Evidence-Based Practice
• Female
• Health Personnel
• Humans
• Interviews as Topic
• Male
• Multimorbidity
• Patient-Centered Care/methods
• Physician-Patient Relations
• Quality of Life/psychology
• Self-Management/methods
• Self-Management/psychology

• ICA-CL-2015-01-003 Department of Health
• NIHR Collaboration for Leadership in Applied Health Research and Care -Wessex

Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are ‘personalised’ to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions.

• Comorbidity
• frailty
• multimorbidity
• polypharmacy

National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.

To identify current assessment methods and access to relevant supporting services for older people with cancer.

A web-based survey (SurveyMonkey) targeting health professionals (oncologists, cancer surgeons, geriatricians, nurses and allied health professionals) was distributed January-April 2016 via United Kingdom nationally recognised professional societies. Responses were analysed in frequencies and percentages. Chi Square was used to compare differences in responses between different groups.

640 health care professionals responded. Only 14.1% often/always involved geriatricians and 52.0% often/always involved general practitioners in assessments. When wider assessments were used, they always/often influenced decision-making (40.5%) or at least sometimes (34.1%). But 30.5%-44.3% did not use structured assessment methods. Most clinicians favoured clinical history taking. Few used scoring tools and few wished to use them in the future. Most had urgent access to palliative care but only a minority had urgent access to other key supporting professionals (e.g. geriatricians, social workers, psychiatry). 69.6% were interested in developing Geriatric Oncology services with geriatricians.

There is variability in assessment methods for older people with cancer across the United Kingdom and variation in perceived access to supporting services. Clinical history taking was preferred to scoring systems. Fostering closer links with geriatricians appears supported.

• Geriatric assessment
• Elderly
• Older
• Cancer
• Support
• Services

• Aged
• Geriatric medicine
• Health manpower
• Health personnel
• Health services for the aged
• Neoplasms
• Older people
• Oncology

• Aged
• Clinical Competence
• Health Knowledge, Attitudes, Practice
• Health Services for the Aged/standards
• Health Workforce/standards
• Humans
• Neoplasms/therapy
• Quality of Health Care
• Staff Development/methods
• Standard of Care

• Macmillan Cancer Support