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Improving Care for Older Adults With Cancer
Cancer is a horrible disease. Providing high quality care often means providing safe, effective and cost-effective treatments that meets a patient’s priority. Reaching these goals, however, is particularly challenging when treating older adults with cancer. A paper on this exact topic by Ramsdale et al (2017) notes that:
Cancer care delivery for older adults with cancer is compromised by tenuous consensus on what constitutes quality and value in cancer care (a you know it when you see it mentality), a paucity of research focused on older adults with cancer, and gaps in services for older adults largely because of an insufficient number of geriatric specialists.
One problem is the available evidence for treating older adults with cancer. One systematic literature review found that 38.5% of randomized controlled trials had inclusion criteria which excluded older adults and 81.3% of trials excluded individuals with common comorbidities. This issue is particularly problematic since many elderly patients have multiple comorbid health conditions including geriatric syndromes such as delirium and frailty.
Another limitation is the supply of experts able to interpret this evidence and deliver care to elderly adults with cancer. There are only 7000 geriatricians in the US today, but by 2030 the US will need nearly more than 35,000 to meet the demand of an aging population.
Additionally, initiatives to improve quality of care for all cancer patients, may lead to inappropriate treatment priorities for treating elderly individuals with cancer.
A focus only on traditional outcomes such as survival and toxicity may neglect the priorities and preferences of the patient. Older patients in particular prioritize other outcomes (such as functional independence and preserved cognition) over survival.
More real-world data and tools are needed to insured trained physicians can provide the care that is needed. For instance, there are some online shared decision-making tools such as:
- E-prognosis.
- CARG Chemotoxicity.
- ACS NSQIP Surgical Risk Calculator.
In short, more evidence is needed, more physicians with expertise in treatment the elderly is needed and more tools are needed.
Commentary posted with permission from Dr Shafrin.
