Specialized assessment programme benefits geriatric cancer patients

The GOLDEN* programme, a geriatric oncology (GO) programme that has been used in a tertiary cancer centre in Singapore, appeared to effectively carry out its objective of optimizing care in older adults with cancer.

“This end-to-end programme was the first of its kind in Singapore … We hope to be able to extend a referral service to community oncologists who may wish to refer their patients to the GOLDEN programme,” said the researchers. “We hope to be able to intervene as early as possible, as a pretreatment assessment.”

The GOLDEN programme was formed in 2019 to support cancer patients right from diagnosis, through treatment, to survivorship. It was formed by merging two pilot programmes in the NCIS** aimed at providing surgical prehabilitation prior to cancer surgery and GO support for those planned for chemo and/or radiotherapy.

Over 2 years, 777 patients (median age 73 years, 57 percent female) were enrolled in the GOLDEN programme. Of these, 569 were enrolled in surgical prehab, 308 in GO support, and 100 in both. Eighty-seven percent of patients had early-stage cancers while the rest had advanced disease. [Oncologist 2023;28:e198-e204]

GO group analysis

Sixty-one percent of patients in this group had a change in their treatment plans based on GOLDEN recommendations, with most receiving an attenuated treatment regimen considering their risk for treatment-related toxicities. “[However,] as this may result in undertreatment … a long-term evaluation of their cancer-related outcomes would be equally crucial,” they said.

About 70 percent had geriatric syndromes which have been tied to adverse outcomes including poorer quality of life (QoL), functional decline, hospitalization, institutionalization, and increased healthcare costs. [J Am Geriatr Soc 2007;55:780-791] “[These could] have been missed if assessment was not performed. These may be overlooked when the focus is solely on treating the cancer. This represents lost opportunity for management and treatment,” the researchers explained.

Of those who completed the EORTC QLQC-30*** questionnaire (n=231), 38 percent reported that they maintained their global health status after enrolling in the programme, while a third reported overall improvement. The researchers said that maintaining QoL during cancer treatment in older adults is critical to “strike a balance between the challenges of physiological ageing and appropriate cancer treatment.”

Of those who completed the patient satisfaction survey (n=233), 73 percent noted that they had benefited from the programme. Among others, some specific points that stood out about the programme for both patients and loved ones were the time spent in discussing their concerns and the provision of a one-stop clinic for intervention after explaining the rationale of prehab.

Barriers to uptake

However, some treating oncologists were reluctant to refer their patients to the programme, mainly because “they would rather prioritize patients’ cancer treatment instead of ‘peripheral geriatric issues’.” Other concerns were the additional consults and potential treatment delays especially for those needing urgent care.

“[Hence,] we intend to evaluate and finetune our work processes to improve the uptake of surgical prehabilitation in older adult cancer patients,” said the researchers.

The sherpa in one’s cancer journey

“We envisioned the GOLDEN programme to be positioned as the sherpa or guide in an older patient’s cancer journey by helping to guide appropriate treatment for older adults and to be a dependable companion to patients and caregivers to provide necessary information and care navigation during this process,” they said.

“The further upstream the patient is in their cancer journey, the more useful this information would be to treating physicians, as it allows them to take into consideration additional information that a geriatric assessment provides prior to formulating a suitable cancer treatment for their patients,” they added.