Geriatric Oncology Clinics May Help Improve Care for Patients With GU Malignancies
A study presented at the 2018 Genitourinary Cancers Symposium (February 8-10, 2018; San Francisco, CA) evaluated the impact of a geriatric oncology clinic on cancer treatment plans and supportive care in older adults with genitourinary cancers.
Older adults with cancer often present with a complex range of comorbidities, polypharmacy, and functional as well as cognitive impairments, which can lead to overtreatment. Prior studies have found that geriatric assessment in older adults with various cancers leads to revised treatment plans in 39% of cases. This finding may support the need for a geriatric oncology clinic, but whether such a clinic can lead to changes in treatment in patients with genitourinary malignancies is unclear.
A group of Canadian researchers conducted a study to examine the impact on the treatment plan of a geriatric oncology assessment in patients with genitourinary cancer. A total of 98 patients aged at least 65 years with a genitourinary malignancy seen in the geriatric oncology clinic at the Princess Margaret Cancer Center (Toronto) from 2015 through 2017 were sampled. Patients were seen by a geriatric oncologist and treatment recommendations were provided to the referring oncologist.
Researchers noted that pre- and post-geriatric oncology clinic treatment plans and enhancements to supportive care were recorded prospectively.
Among the total patient population, 35 were seen pre-treatment, of whom 25 had prostate cancer, 5 had kidney cancer, and 5 had bladder cancer. Thirty-one of these 35 patients were referred for input on the treatment plan. The initial treatment plan included surgery (n = 6), radiation (n = 14), systemic therapy (n = 8), and hormonal therapy (n = 11). The final treatment plan was intensified in 1 patient, reduced in 6 patients, changed to best supportive care in 8 patients, and unchanged in 15 patients.
Researchers reported that treatment modification occurred in 52% of patients. Enhancements to supportive care included comorbidity management (87%), educational support (94%), disease-related symptoms (39%), and peri-operative management (19%).
In their concluding remarks, researchers asserted that the geriatric oncology clinic resulted in modifications to the proposed treatment plan—most notably a reduction in treatment intensity—in over half of referred patients, as well as enhancements to supportive care in the vast majority of patients. “Geriatric oncology clinics have the potential to avoid overtreatment and improve care for older adults with genitourinary malignancies,” they wrote.—Zachary Bessette