Published online Mar 24, 2020. doi: 10.5306/wjco.v11.i3.152
Peer-review started: October 18, 2019
First decision: November 5, 2019
Revised: December 20, 2019
Accepted: January 1, 2020
Article in press: January 1, 2020
Published online: March 24, 2020
The United Kingdom Independent Taskforce report “Achieving World-Class Cancer Outcomes” calls for improved assessment methods for older people. Existing evidence and international bodies such as the American Society of Clinical Oncology and the International Society of Geriatric Oncology support this concept and recommend routine comprehensive geriatric assessment. However, assessment methods across a nation have yet to be described.
Older patients with cancer often have complex multi-morbidity and wider needs. These patients have poorer outcomes and are less likely to receive curative treatment. By better understanding current clinical assessment methods, future clinical care pathways can be designed around gaps in practice and be evaluated for effectiveness.
This nationwide survey aimed to identify current assessment methods and access to relevant supporting services for older people with cancer. By understanding current clinical practice and views, future research can focus towards interventions likely to be most acceptable and useful.
A web-based survey was distributed between January to April 2016 via United Kingdom nationally recognised professional societies. The survey targeted relevant health professionals working with older people with cancer in the United Kingdom.
There was variability in assessment methods and access to supporting services for older people with cancer in the United Kingdom. Health professionals preferred performance status and traditional history-taking to scoring tools. Few had geriatricians involved in the assessment of older people and only half involved general practitioners. Access to key multidisciplinary team members was variable. This is the first study to describe assessment methods used by front-line clinicians in the United Kingdom. This data is important to informing design of future services to improve clinical assessment and support for older people with cancer.
There was variability in assessment methods and access to supporting services. Clinical history taking was preferred to scoring systems. Future research evaluating delivery of comprehensive geriatric assessment should bear these results in mind. Future studies should consider moving away from scoring tools if the intention is for use in clinical practice. Developing care pathways to better link up existing supporting services would be a helpful initial step to improve access to key other professionals.
A number of questions remain. How can comprehensive geriatric assessment be feasibly embedded within cancer care pathways across a nation? Is the workforce adequately trained to managed co-existing needs alongside cancer treatment? If not, would changes in education provide cancer services with the skills to better manage complex older patients? Or is collaborative working more effective? How can we test new assessment methods for feasibility and clinical effectiveness in cancer services?