1
|
Bagayogo F, Le Berre M, Ruchon C, Denis JL, Lamothe L, Vedel I, Lapointe L. Caring for older cancer patients: A scoping review. Health Policy 2020; 124:1008-1016. [PMID: 32532568 DOI: 10.1016/j.healthpol.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/08/2019] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, treat, follow-up and rehabilitate the population of older cancer patients. Geriatric oncology is still struggling to establish itself in healthcare settings managing older cancer patients. Efforts are currently being made to make it a recognized medical specialty. Health policy makers have to have a grasp of the evolution of this discipline because it concerns a fast growing segment of the cancer patient population. To shed light on the literature about this field, we undertook a scoping review in which we identified relevant studies; charted the data from the selected studies, collated, summarized and reported the results. From 2043 references initially identified, we included 92 articles in our scoping review and extracted data from 88 articles. The included articles were classified into three major categories, namely Advancing the discipline, Organization of care and Nursing and support services for patient and their caregivers. This review affords researchers and policy makers a foundation to help conduct many other conversations on each theme and sub-theme.
Collapse
Affiliation(s)
- Fatou Bagayogo
- York University School of Health Policy and Management, Canada.
| | - Mélanie Le Berre
- Lady Davis Institute of the Jewish General Hospital, 5858 Côte-des-Neiges road 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Christian Ruchon
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges road, 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Jean-Louis Denis
- School of Public Health, Université de Montréal (ESPUM), 7101 Parc Avenue, 3rd floor, offices 3014-8, H3N 1X9, Montreal, Québec, Canada; Research Center of the CHUM (CRCHUM), 900 Saint-Denis street, H2X 0A9, Montreal, Québec, Canada
| | - Lise Lamothe
- School of Public Health, Université de Montréal (ESPUM), 7101 Parc Avenue, 3rd floor, offices 3014-8, H3N 1X9, Montreal, Québec, Canada
| | - Isabelle Vedel
- Lady Davis Institute of the Jewish General Hospital, 5858 Côte-des-Neiges road 3rd floor, H3S 1Z1, Montreal, Québec, Canada; Department of Family Medicine, McGill University, 5858 Côte-des-Neiges road, 3rd floor, H3S 1Z1, Montreal, Québec, Canada
| | - Liette Lapointe
- Desautels Faculty of Management, McGill University, 1001 Sherbrooke Street West, Montreal, Quebec, H3A 1G5, Canada
| |
Collapse
|
2
|
Hurria A, Cohen HJ, Extermann M. Geriatric Oncology Research in the Cooperative Groups: A Report of a SIOG Special Meeting. J Geriatr Oncol 2010; 1:40-44. [PMID: 21218146 DOI: 10.1016/j.jgo.2010.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE: The purpose of this meeting was to bring together geriatric oncology researchers in the cooperative groups to discuss the design of clinical trials to improve our knowledge of the efficacy and toxicity of cancer therapeutics in older adults with cancer. DESIGN: Meeting of cooperative group leaders in geriatric oncology research RESULTS: Several strategies were suggested to improve our knowledge of the efficacy and toxicity of cancer therapeutics in older adults. These include: 1) developing therapeutic studies for older adults who are not eligible for standard clinical trials (because of comorbidity or functional status), or for patients who are deemed to be at high risk for toxicity from standard therapy (frail or vulnerable); 2) identifying the age group of older adults who are underrepresented on clinical trials and developing trials specifically for these patients; 3) designing trials to include a certain proportion of older adults for subset analyses; and 4) including a geriatric assessment in therapeutic clinical trials in order to identify factors other than chronologic age that identify those older adults who are "vulnerable" (at risk for toxicity) and "fit" (able to tolerate cancer therapy without significant toxicity). CONCLUSIONS: To address knowledge gaps in geriatric oncology, national and international cooperative group leaders discussed strategies in clinical trial design to improve the evidence-based research and accrual of older adults. Linking the efforts among cooperative groups will expedite this progress, and this conference was a major first step toward this goal.
Collapse
Affiliation(s)
- Arti Hurria
- Director, Cancer and Aging Research Program, City of Hope, 1500 E. Duarte Road, Duarte, CA 91010, , Phone 626-256-4673 x64173, FAX: 626-301-8898
| | | | | |
Collapse
|
3
|
Bellizzi KM, Rowland JH. Role of comorbidity, symptoms and age in the health of older survivors following treatment for cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/1745509x.3.5.625] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Men and women aged over 65 years represent 60% of the 10.8 million cancer survivors in the US. The proportion of older cancer survivors will increase significantly with the aging of the population. Unlike younger survivors, the experience of cancer in those diagnosed with cancer as older adults is often superimposed on existing health conditions, which disproportionately affect the elderly population. Understanding the extent to which having cancer contributes to decrements in physical, mental and social function, above and beyond the influence of other chronic health conditions and normative aging, will be critical to the long-term care of older cancer survivors. In this article, we review the extant research on the influence of comorbidity, symptoms and age on the health and functioning of older survivors following treatment for cancer. Future research directions are highlighted, along with several approaches to advancing the field, including the identification of strategies to deliver care to the older population after cancer treatment, changing how we view older adults and consider their health, and, finally, finding systematic approaches to monitor the impact of cancer on older survivors’ health and wellbeing.
Collapse
Affiliation(s)
- Keith M Bellizzi
- National Cancer Institute, Office of Cancer Survivorship, 6116 Executive Blvd, Suite 404, MSC 8336, Bethesda, MD 20892, USA
| | - Julia H Rowland
- National Cancer Institute, Office of Cancer Survivorship, 6116 Executive Blvd, Suite 404, MSC 8336, Bethesda, MD 20892, USA
| |
Collapse
|
4
|
Step by step development of clinical care pathways for older cancer patients: necessary or desirable? Eur J Cancer 2007; 43:2170-8. [PMID: 17870519 DOI: 10.1016/j.ejca.2007.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 02/07/2023]
Abstract
Medical and nursing staff in oncology for older cancer patients are confronted with a range of problems including co-morbidity, poly-pharmacy, cognitive impairments, emotional problems, functional limitations, sensory impairment and a lack of social support. Comprehensive geriatric assessment identifies many of the existing problems and can be used to estimate life expectancy and tolerance of treatment. However, health care providers have to interpret and apply the medical and nursing information and must deal with specific problems and care needs throughout the continuum of cancer care. Imperfect interdisciplinary communication, cooperation and patient-provider communication may further complicate the care actually delivered. A clinical care pathway aims to improve continuity, increase multidisciplinary tuning and deliver appropriate patient education, treatment and care for vulnerable older cancer patients. This paper gives an overview of common problems in older cancer patients and addresses communication barriers through the development of clinical care pathways in geriatric oncology.
Collapse
|