Evidence-Based Medicine
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2020; 11(3): 152-161
Published online Mar 24, 2020. doi: 10.5306/wjco.v11.i3.152
Assessment methods and services for older people with cancer in the United Kingdom
Tania Kalsi, Danielle Harari
Tania Kalsi, Danielle Harari, Department of Ageing and Health, Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, United Kingdom
Tania Kalsi, Danielle Harari, King’s College London, Capital House, London SE1 3QD, United Kingdom
Author contributions: Kalsi T and Harari D led design of survey with the United Kingdom Geriatric Oncology Expert Reference Group contributing to iterations; Kalsi T led survey distribution and analysis of survey; Kalsi T and Harari D writing of manuscript.
Conflict-of-interest statement: There are no conflicts of interest arising from this work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tania Kalsi, MBBS, MD, MRCP, Doctor, Department of Ageing and Health, 9th Floor North Wing, St Thomas' Hospital, Guys and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom. tania.kalsi@gstt.nhs.uk
Received: October 18, 2019
Peer-review started: October 18, 2019
First decision: November 5, 2019
Revised: December 20, 2019
Accepted: January 1, 2020
Article in press: January 1, 2020
Published online: March 24, 2020
Processing time: 150 Days and 16.1 Hours
Abstract
BACKGROUND

National cancer strategy calls for comprehensive assessments for older people but current practice across the United Kingdom is not well described.

AIM

To identify current assessment methods and access to relevant supporting services for older people with cancer.

METHODS

A web-based survey (SurveyMonkey) targeting health professionals (oncologists, cancer surgeons, geriatricians, nurses and allied health professionals) was distributed January-April 2016 via United Kingdom nationally recognised professional societies. Responses were analysed in frequencies and percentages. Chi Square was used to compare differences in responses between different groups.

RESULTS

640 health care professionals responded. Only 14.1% often/always involved geriatricians and 52.0% often/always involved general practitioners in assessments. When wider assessments were used, they always/often influenced decision-making (40.5%) or at least sometimes (34.1%). But 30.5%-44.3% did not use structured assessment methods. Most clinicians favoured clinical history taking. Few used scoring tools and few wished to use them in the future. Most had urgent access to palliative care but only a minority had urgent access to other key supporting professionals (e.g. geriatricians, social workers, psychiatry). 69.6% were interested in developing Geriatric Oncology services with geriatricians.

CONCLUSION

There is variability in assessment methods for older people with cancer across the United Kingdom and variation in perceived access to supporting services. Clinical history taking was preferred to scoring systems. Fostering closer links with geriatricians appears supported.

Keywords: Geriatric assessment; Elderly; Older; Cancer; Support; Services

Core tip: There was variability in assessment methods and access to supporting services for older people with cancer in the United Kingdom. Performance status and traditional history-taking was preferred to scoring tools. Future studies should consider moving away from scoring tools if the intention is for use in clinical practice. There was variability in access to key supporting services. Developing care pathways to better link up existing services would be helpful. Collaborative working with geriatricians appears supported. A number of questions remain. How can comprehensive geriatric assessment be feasibly embedded within cancer care pathways across a nation?