By 2030, it is estimated that 70% of cancers in the United States will be diagnosed in older adults, and by 2040 nearly three-fourths (73%) of the country’s cancer survivors will be aged 65 years or older.1,2 This demographic shift underway in the US cancer patient population was highlighted in the 2013 National Academy of Medicine report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, which concluded that our care delivery system is underprepared to address the specific needs of older adults with cancer.3 In 2014, the Journal of Clinical Oncology published a series of articles on the status of geriatric oncology treatment and survivorship care.4
These reports and others that are specific to the older adult cancer patient population mention the following challenges2-6:
- Polypharmacy due to high incidence of comorbidities and use of concomitant medications
- Age-related physiologic changes affecting overall health and response to treatment including potentially increased side effects
- Co-occurrence of mobility, functional, nutritional, and cognitive decline and impairments
- Under-representation of older adults in clinical trials resulting in limited evidence for clinical decision-making
- Current and anticipated future shortage of geriatricians and geriatric oncology professionals
- Financial, systemic, and practical barriers to accessing care
- Lack of adequate psychosocial support
- Heterogeneity of the older adult cancer patient population, ie, differing goals of care and desired outcomes regarding survival and quality of life, functional status, and pain
Enter the Geriatric Assessment
As the oncology community adapts to new reimbursement models in tandem with increasing reporting requirements to demonstrate value and quality improvement; evolving guidelines and clinical advances; and mounting operational and management challenges, the Association of Community Cancer Centers (ACCC) education on Multidisciplinary Approaches to Caring for Geriatric Patients with Cancer brings the focus back to the realities of an aging cancer patient population with practical, actionable information and resources that cancer care providers can use today to better prepare for tomorrow.
To assess oncology community awareness and current practices around utilization of screening, assessment, and care for older adults with cancer, ACCC surveyed its membership in 2018. Based on more than 300 responses from oncology professionals, the survey revealed a striking chasm between respondents’ beliefs and practices. While 95% of respondents “strongly agree” or “agree” that older adult cancer patients would benefit from a comprehensive geriatric assessment (CGA) in addition to the oncology assessment before the start of treatment, only 17% reported that they routinely perform such CGAs. Respondents cited the following top three barriers to conducting CGAs: limited time (60%), limited familiarity with validated geriatric screening/assessment tools (49%), and limited personnel (46%).
Survey results informed the project’s expert advisory committee in curating and creating materials for the Multidisciplinary Approaches to Caring for Geriatric Patients with Cancer online resource hub, which includes a webinar series presented by leaders in geriatric oncology; a publication with current recommendations for conducting CGAs, with examples of how these assessments have impacted patient care; practical suggestions for first steps in integrating screening or geriatric assessment into practice; an online resource library with validated geriatric assessment tools; and more.
Key Project Takeaways
There is no one-size-fits all solution to improving care for the older adult cancer patient population. Oncology care providers must consider their own resources, capacities, and patient needs, specific to their region and location. Through the combined efforts of geriatric oncology researchers, professional organizations, the Cancer and Aging Research Group (CARG), The Gerontological Society of America, the International Society of Geriatric Oncology, and others, there are validated tools available for improving the care of senior adults with cancer. Using just one of the above tools can take as little as 30 seconds of clinicians’ time but can make a significant impact on clinical decisions and the provision of patient-centered care. Learn more and access resources at accc-cancer.org/geriatric.
1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27(17):2758-2765. doi:10.1200/JCO.2008.20.8983
2. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “Silver Tsunami”: prevalence, trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029-1036. doi:10.1158/1055-9965.EPI-16-0133
3. Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population; Board on Health Care Services; Institute of Medicine. Levit L, Balogh E, Nass S, et al, eds. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC: National Academies Press (US); 2013.
4. American Society of Clinical Oncology. J Clin Oncol. 2014;32(24):2521-2678 [entire issue].
5. Hurria A, Levit LA, Dale W, et al. Improving the evidence base for treating older adults with cancer: American Society of Clinical Oncology statement. J Clin Oncol. 2015;33(32):3826-3833. doi:10.1200/JCO.2015.63.0319
6. Lichtman SM, Hurria A, Jacobsen PB. Geriatric oncology: an overview. J Clin Oncol. 2014;32(24):2521-2522. doi:10.1200/JCO.2014.57.4822