40COMPREHENSIVE GERIATRIC ASSESSMENT INFLUENCES ONCOLOGY DECISION-MAKING FOR OLDER PEOPLE WITH CANCER

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Abstract

Introduction: There has been little research evaluating comprehensive geriatric assessments (CGA) in relation to cancer treatment decisions. The purpose of this service evaluation was to assess the impact of CGA on oncologist decision-making in the treatment of older people with cancer.

Innovation: Geriatrician-led CGA was performed targeting people aged 65+ with comorbidities, as part of the Geriatric Oncology Liaison Development (POPS-GOLD) research/service innovation pilot. We asked oncologists for semi-structured feedback via email on the influence of the assessment on decision-making for a subgroup of 40 consecutive patients.

Evaluation: Patients had mean age 77 years (range 64–90), 78% male, with colorectal (18), prostate (9), bladder (6) and other (7) cancers; 60% (n = 24) of oncologists responded (20.8% consultants, 62.5% registrars, 16.7% clinical nurse specialists). All the respondents had read the CGA assessment letter at the patient's next cancer appointment; 62.5% (n = 15) reported the assessment had influenced their decision-making. Of these, 67% (n = 10) reported CGA assisted the evaluation of fitness for treatment, more often in favour of active treatment (eight versus two patients). Common themes reported as beneficial were medical review (n = 5), increased information (n = 3), facilitated communication (n = 2) and increased confidence (n = 3). Symptoms previously attributed to chemotherapy side effects were identified as medications/medical causes in two (‘it was so helpful…we thought he might have had a cardiac problem related to the chemo but you have identified the culprit drug. Based on your consultation, we decided to continue chemotherapy without any dose reductions’). Of the nine who reported no influence on decision-making, five found it useful for other reasons (‘the reduction in antihypertensives likely to mean he will tolerate radiotherapy’).

Conclusion: Early CGA can influence oncology decision-making. Feedback suggests that this relates not only to improved medical support and the information provided, but also to increasing confidence to actively treat older people with cancer.

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