Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer
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ORIGINAL ARTICLE
Comprehensive geriatric assessment and decision-making in older men with incurable but manageable (chronic) cancer Catherine Handforth 1,2 & Roger Burkinshaw 1 & Jenny Freeman 1 & Janet E. Brown 1,2 & John A. Snowden 1,3 & Robert E. Coleman 1,2 & Diana M. Greenfield 1,2 Received: 31 May 2017 / Accepted: 8 August 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Purpose In older cancer patients, treatment decision-making is often complex. A comprehensive geriatric assessment (CGA) is an established tool used in geriatric medicine to identify unmet need requiring intervention. This study aimed to assess whether using a CGA in older male cancer patients with incurable but manageable disease provides information that would alter a cancer clinician’s intended management plan. Acceptability and feasibility were secondary aims. Methods Elderly men with incurable but manageable malignancies (advanced prostate cancer and multiple myeloma) who had previously received at least one line of treatment were recruited from hospital outpatient clinics. A CGA was undertaken. Additional parameters measuring pain, fatigue and disease-specific concerns were also recorded, at the recommendation of patient involvement groups. Results were made available to clinicians. Patient and clinician acceptability and changes in subsequent management were recorded. Results Forty-eight patients completed the study. The median ages were 70.8 years and 74 years for myeloma and prostate respectively. Most identified concerns are related to disease-specific concerns (93%), pain (91%), frailty (57%) and nutrition (52%). Results altered the clinician’s oncological management plan in nine cases only. Patients found the format and content of CGA acceptable. Conclusions Many unmet needs were identified in this population of elderly men with manageable but non curable cancer which led to supportive care referrals and interventions. The CGA, however, did not result in significant changes in clinical oncology treatment plans for the majority of patients. The application of the CGA and other assessments was viewed positively by participants and can feasibly be undertaken in the outpatient oncology setting. Keywords Comprehensive geriatric assessment . Advanced prostate cancer . Multiple myeloma
Introduction More than half of new cancer diagnoses in North America and Europe occur in patients aged over 65, a figure which is
* Catherine Handforth [email protected] Diana M. Greenfield [email protected] 1
University of Sheffield, Sheffield, UK
2
Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Whitham Road, Sheffield S10 2SJ, UK
3
Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield S10 2JF, UK
projected to increase significantly as a result of the ageing population [1]. Older cancer patients often have complex clinical needs at the time of diagnosis. These may arise as a direct consequence of their malignancy, but can also r
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