Geriatric Oncology: Past, Present, Future
01 Jul 2008-Journal of Oncology Practice (American Society of Clinical Oncology)-Vol. 4, Iss: 4, pp 190-192
TL;DR: Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.
Abstract: Efforts to integrate geriatric oncology principles in the training of all medical oncologists are underway.
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TL;DR: It was found that polypharmacy was common in older cancer patients and increased during hospitali-zation, and most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the O ACE team.
Abstract: Background: A novel Oncology-Acute Care for Elders (OACE) unit that uses an interdisciplinary team to enhance recognition and management of geriatric syndromes in hospitalized older adult cancer patients has been established at Barnes-Jewish Hospital (St. Louis, Missouri). The OACE team includes a clinical pharmacist whose primary role is to improve the appropriateness of prescribing. Objective: Using polypharmacy as the prototypical geriatric syndrome addressed by the OACE team, the objective of this study was to document the processes of communication of an interdisciplinary team and the impact on polypharmacy when the treating physician did not participate in the daily interdisciplinary team rounds. Methods: This was a prospective, observational study of older cancer patients admitted to the OACE unit. We tracked processes and outcomes of interdisciplinary communication regarding medications by prospectively recording OACE team recommendations and evaluating the frequency of implementation of these recommendations through a chart review. Treating physicians, who did not attend team rounds, received these recommendations on a communication form placed in the patient's chart. Results: Forty–seven patients were included in the study. The mean (SD) age was 73.5 (7.5) years. Twenty–one percent (10/47) of patients were prescribed ≥1 Beers medication as part of their home-care regimen before admission to the OACE unit. The OACE team made 51 medication recommendations, and 42 of those recommendations (82%) were implemented. Twenty–five patients (53%) had an alteration in their medication regimen; 13 (28%) had a potentially inappropriate medication discontinued. A medication error was corrected in ~1 of every 8 patients (6/47 [13%]). Conclusions: We found that polypharmacy was common in older cancer patients and increased during hospitali-zation. We also found that most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the OACE team. Future randomized trials are needed to assess the impact of the OACE team model of care on adverse events, survival, and cost in hospitalized older adult cancer patients.
80 citations
TL;DR: The LIVESTRONG Young Adult Alliance, a Lance Armstrong Foundation program and a result of the Adolescent and Young Adult Oncology Progress Review Group, assembled a group of experts representing relevant medical, psychosocial, and advocacy disciplines to create a blueprint for the training and development of health care professionals caring for AYA patients with cancer.
Abstract: We outline here the essential elements of training for health care professionals who work with adolescent and young adult (AYA) patients with cancer. Research is emerging that a number of cancers manifest themselves differently in the AYA population, both in terms of biology and treatment response. In addition, there are a number of issues uniquely experienced by the AYA population that are critical for health care professionals working within AYA oncology (AYAO) to understand. The LIVESTRONG Young Adult Alliance, a Lance Armstrong Foundation program and a result of the Adolescent and Young Adult Oncology Progress Review Group cosponsored by the Lance Armstrong Foundation and the National Cancer Institute, assembled a group of experts representing relevant medical, psychosocial, and advocacy disciplines to create a blueprint for the training and development of health care professionals caring for AYA patients with cancer. The Alliance recommends that all health care professionals working in AYAO receive training that provides expertise in the following three critical areas: AYA-specific medical knowledge; care delivery specific to AYAs relative to pediatric and older adult populations; and competency in application and delivery of AYA-specific practical knowledge. These three areas should form the foundation for curricula and programs designed to train health care professionals caring for AYAO patients.
74 citations
Cites background from "Geriatric Oncology: Past, Present, ..."
...The evolution of the field of AYAO from special forums, lectures, continuing medical education activities, and courses to integrated formal subspecialty training and certification may follow a path similar to that of the field of geriatric oncology.(11) Various models for AYAO fellowships are already being explored, including either as combined fellowship training in both pediatric and adult medical oncology or as additional training after completion of either fellowship alone....
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TL;DR: Key strategies to accelerate the uptake and impact of educational initiatives to address this gap include the use of effective educational strategies, broad dissemination of educational material that is freely available, and the integration of geriatric oncology topics into teaching, curriculum, assessments and exams.
45 citations
National Institutes of Health1, West Virginia University2, Louisiana State University3, Northern Arizona University4, American Physical Therapy Association5, Edinburgh Napier University6, Brigham and Women's Hospital7, University of Texas MD Anderson Cancer Center8, University of Pittsburgh9, Harvard University10, Mayo Clinic11, New York University12, Pennsylvania State University13, American Cancer Society14
TL;DR: This research highlights the need to understand more fully the role of emotion in the decision-making process and the role that emotion plays in the development of new treatments for depression.
Abstract: There are approximately 17 million cancer survivors living in the United States and by 2040 this estimate is predicted to increase to 26.1 million.1 Exercise provides a myriad of health benefits to individuals during and after cancer treatment by reducing treatment-related symptoms, improving functional status and quality of life, and lowering risk of disease recurrence.2,3 Despite the established benefits, an individual’s level of physical activity often decreases during treatment and does not return to pre-diagnosis levels after treatment completion.4,5 While exercise is regarded as safe and beneficial for individuals with cancer, promoting exercise for this population is complex. A patient-centered pathway is needed that can guide oncology and primary care professionals in efficient assessment of an individual’s condition and enable personalized referrals for exercise interventions that promote physical activity. The purpose of this manuscript is to provide a framework for clinical decision making that enables personalized condition assessment, risk stratification, and referral to optimal settings for exercise promotion for cancer survivors. Implementation strategies are also offered to support the integration of this model into an oncology clinical workflow.
With guidance from their medical provider, individuals are more likely to engage in exercise and maintain levels of physical activity during cancer treatments.6 However, the number of individuals with cancer who report receiving exercise-specific guidance from their health care providers is low.7 Of particular concern is the lack of knowledge and training among health care professionals about exercise prescription for this complex population.8
43 citations
TL;DR: The field must strengthen its research in clinical trials and comparative outcomes, and must articulate the key competencies that distinguish a practitioner of young adult oncology (both to define clinical programs and educational curricula).
37 citations
References
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TL;DR: Researchers in this area have shown that traditional oncology measures of performance are not adequate in older patients and that geriatric specific measures, such as activities of daily living and instrumental activities ofdaily living, have a much greater predictive value.
Abstract: A saying within oncology is: If you’re not a pediatric oncologist, you’re a geriatric oncologist. Maybe while not literally true, this phrase is recognition that all of the subspecialties of oncology are rapidly becoming a field that will be primarily concerned with the care of older patients. While there is not one precise definition of the age of geriatric patients, it is clear that the aging of our society has necessitated a focus on this segment of the population. It has long been recognized that the most significant risk factor for the development of cancer is increasing age. This, together with epidemiologic shifts, has resulted in a marked increase in the number of older patients with cancer, which will markedly increase the cancer burden to the world. It may also compromise the life expectancy, as well as the active life expectancy, of older individuals. Cancer and cancer treatment may appear as several of the prime causes, not only of mortality, but also of disability, in older individuals. The traditional ways in which cancer is studied—by clinical trials focusing on younger, healthier patients—has left us devoid of useful data with which to treat older patients in an evidenced-based fashion. Not only have these earlier trials failed to establish the relative efficacy of cancer treatment in the elderly, but they also were unable to provide information related to the shortand long-term complications of treatment including decline in function. Among the first to recognize this issue was Dr Rosemary Yancik, who in 1983 organized a symposium sponsored by the National Cancer Institute and the National Institute on Aging, which resulted in a monograph, “Perspectives on Prevention and Treatment of Cancer in the Elderly.” The conference reached a number of conclusions and set a research agenda (Tables 1 and 2). In the 1988 American Society of Clinical Oncology (ASCO) Presidential Address, Dr B.J. Kennedy encouraged the study of aging and cancer. He stated “ . . .our society need not ration how we will treat our disadvantaged members, but should continue to seek those preventive and positive measures that can shorten our later period of morbidity. A very major cancer load will persist well into the 21st century, even if the attempts at prevention are eventually a total success. There is a developing knowledge on aging. Care of the older person needs to be part of medical education and oncology education. Research will help attain a desirable quality of life with aging and a reduced morbidity.” Since that time, studies of older cancer patients have revealed a significant amount of important clinical information. This has included the degree and severity of comorbidity and its effect on treatment, the role of polypharmacy, and the various social and financial problems facing older patients with cancer. The relative and absolute under-representation of older patients in clinical trials has been amply documented. The adverse outcomes of inadequate dosing and supportive care in both curative and palliative treatments have been demonstrated in a number of treatment settings. Even when clinical trials are available, barriers to participation of older patients have been shown to be primarily due to physician reluctance due to fear of toxicity, limited expectation of benefit, or ageism. A number of important strides have been made in the evaluation of older patients through various methodologies of geriatric assessment. The Comprehensive Geriatric Assessment developed by geriatricians is a multidisciplinary evaluation of the older patient encompassing a number of important clinical domains. Researchers in this area have shown that traditional oncology measures of performance are not adequate in older patients and that geriatric specific measures, such as activities of daily living and instrumental activities of daily living, have a much greater predictive value. Table 1. Prospects for Cancer Control in the Elderly
75 citations