Authors (including presenting author) :
Liu TC(1), Wong CY(1), Chan K(1), Soong IS (1), Tsui TW(1), Chan YK(2), Kwok YJ(2), Tong WH(3), Yu CW(3), Chiang WH(3), Cheung T(4), Chan YJ(4), Leung SN(4), Lee MH (4), Lam CY(5), Chan WS(5), Chan WW(5), Shiu CK (1), Lee CK(6)
Affiliation :
(1)Department of Clinical Oncology, (2)Department of Medicine, (3)Department of Physiotherapy, (4)Department of Occupational Therapy, (5)Department of Dietetics, (6)Department of Medical Social Worker, Pamela Youde Nethersole Eastern Hospital
Introduction :
The Hong Kong Cancer Registry shows that 54% of cancer patients were aged 65 years or above. Treating elderly cancer patients is a challenge for they are prone to treatment morbidity and mortality as reflected by our service audit in 2020/2021 which showed that 56% of treatment-related deaths or ICU admissions were aged 65 or above.
Global effort was taken to meet this challenge. American Society of Clinical Oncology, National Comprehensive Cancer Network, and International Society for Geriatric Oncology recommend the implementation of comprehensive geriatric assessment (CGA) for cancer patients aged 65 or above.
Objectives :
To establish a Geriatric Oncology Pilot Program in Pamela Youde Nethersole Eastern Hospital in accordance with international recommendation.
To test the feasibility of applying CGA via a multidisciplinary collaboration platform aiming for improving management decision making and reduction of cancer treatment related mortality/ morbidities in geriatric patients.
Methodology :
Patients aged 65 years old or above planning for chemotherapy or radical radiotherapy were eligible for CGA after screening by the G8 geriatric screening tool with low G8 score i.e. <=14.
Multidisciplinary assessment by oncologist, geriatrician, physiotherapist, occupational therapist, dietitian and medical social worker would be conducted via “one-stop shop” approach.
Result & Outcome :
Forty-one non-consecutive patients were screened from September 2021 to November 2022. Twenty-five patients (60%) had a low G8 score <=14, they were recruited into the program. The median age was 75. The treatment intent was definitive in 28%, adjuvant in 36%, and palliative in 36%. Intended treatment in 80% were chemotherapy, 20% were radical radiotherapy. The cancer diseases were diverse, including breast (20%), colorectal (28%), head and neck (8%), lung (24%), upper gastrointestinal (4%), urogenital (12%) and hepatobiliary (4%) cancers.
After CGA, treatment decisions were influenced in 36% of patients. Among patients who were planned for definitive or adjuvant treatment, 75% were able to complete the intended treatment without significant delay and toxicity. Among frail palliative patients, there were no ICU admissions during treatment. Unscheduled hospitalization due to treatment toxicities occurred in 20% of patients. We observed more complications in head and neck cancer patients, which may guide our future service.
The pilot program confirmed the feasibility of multidisciplinary CGA for geriatric cancer patients. Our experience suggests that screening guided CGA is a feasible service platform. The program can refine the decision making, devise an adapted treatment strategies and facilitate discussion with geriatric cancer patients & family for reducing treatment morbidities and mortalities.
