Geriatric Assessment and Intervention (GAIn) Pathway
Project description
The team at Flinders Center for Innovation in Cancer (FCIC) have piloted a pathway for Geriatric Assessment and Intervention (GAIn) for older patients with cancer. Newly diagnosed patients aged 70+ years, planned for systemic therapy, participate in a number of best practice geriatric assessments (such as ECOG performance status, G8 frailty score, Cancer and Ageing Research Group (CARG) Toxicity Scores and CIRS-G for competing comorbidities), prior to commencing treatment. Data gathered from these assessments is then utilised to help with the clinician’s decision-making process for recommending personalised treatment, leading to improved health outcomes.
There is compelling evidence that geriatric assessment in older patients with cancer, improves tolerance to treatment, reduces toxicity and identifies patients at higher risk of mortality, frailty and other age-related morbidity, that could negatively impact health outcomes. Failure to do so could lead to overtreatment of a frail patient, or undertreatment of a fit patient. Despite evidence and recommendations for geriatric assessment in older patients with cancer, this is not routinely practiced and/ or integrated into routine oncological care, especially within Australia.
The Geriatric Assessment and Intervention (GAIn) Pathway ensures that patients at risk are identified early, assessed appropriately using evidenced-based geriatric screening and assessment, and offered personalised intervention to prevent toxicities and improve health to ensure best health care outcomes.
Outcomes
The Geriatric Assessment and Intervention Pathway will lead to:
Early identification of ‘at risk’ patients, leading to personalised treatment plan
Reduced toxicities from treatment
Patients feeling reassured with tailored care
Improved self-efficacy
Patients have better understanding of their diagnosis and treatment plan
Enhanced clinician-patient communication
Provided a streamlined avenue for tailored geriatric intervention, i.e. early referral to dietician, cancer rehab, social worker, cancer council, cancer hotline, polypharmacy review.
Enhanced quality of life for the patient and their family/caregivers
Impact on the healthcare professional
The GAIn assists both clinicians and patients, by facilitating a personalised approach to recommended treatment options while carefully considering the treatment efficacy, risk for toxicity, treatment intent, and patient preference.
Impact on the healthcare institution
While many older patients with cancer are now routinely assessed for fitness prior to commencing systemic anticancer therapy since the introduction of geriatric screening at the Flinders Centre for Innovation in Cancer, the routine integration of geriatric screening remains challenging. Due to limited resources, less than half of those eligible for geriatric screening were evaluated highlighting the need for greater resourcing to ensure a uniform and consistent approach to ensure best possible care of older people living with cancer.
Proposer
Flinders Centre for Innovation in Cancer
Level 4, 1 Flinders Drive Bedford Park, SA 5042
Project contact person:
Dr Anna Mislang
anna.mislang@sa.gov.au
Project team members:
Dr. Anna Mislang (Medical Oncologist)
Prof. Chris Karapetis (Head of Unit, Medical Oncology)
Ms. Helen Martin (Pharmacologist)
Ms. Caroline Richards (Nurse, Cancer Care Coordinator)