Capacity to Provide Geriatric Specialty Care for Older Adults in Community Oncology Practices

The oncologist

article

Grant R. Williams¹  Charles S. Kamen²  Joseph M. Unger³  Supriya G. Mohile²  Heidi D. Klepin⁴  Kathryn E. Weaver⁴  Glenn J. Lesser⁴  Emily Dressler⁴  Karen M. Winkfield⁴  Heather B. Neuman⁷  Anne E. Kazak⁸  Ruth Carlos⁹  Lucy J. Gansauer^1,10 

[1] O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham;James Wilmot Cancer Institute, University of Rochester;Fred Hutchinson Cancer Research Center, University of Washington;Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine;Department of Social Sciences and Health Policy, Wake Forest School of Medicine;Department of Biostatistics and Data Science, Wake Forest School of Medicine;Division of Surgical Oncology, University of Wisconsin;Nemours Children's Health System;University of Michigan Comprehensive Cancer Center, University of Michigan;Spartanburg Regional Medical Center

关键词: Cancer care delivery;    Aging;    Geriatric oncology;    Community oncology;    Geriatric assessment;   

DOI  :  10.1634/theoncologist.2020-0189

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background American Society of Clinical Oncology guidelines recommend that patients ≥65 years of age starting chemotherapy undergo a geriatric assessment (GA) to inform and guide management; however, little is known about resources available in community oncology practices to implement these guidelines and to facilitate geriatric oncology research. Materials and Methods Oncology practices within the National Cancer Institute Community Oncology Research Program (NCORP) were electronically surveyed in 2017 regarding the availability of specialty providers, supportive services, and practice characteristics, as part of a larger survey of cancer care delivery research capacity. Results Of the 943 NCORP practices, 504 (54%) responded to the survey, representing 210 practice groups. The median new cancer cases per year ≥65 years of age was 457 (interquartile range 227–939). Of respondents, only 2.0% of practices had a fellowship-trained geriatric oncologist on staff. Geriatricians were available for consultation or comanagement at 37% of sites, and of those, only 13% had availability within the oncology clinic (5% of overall). Practice size of ≥1,000 new adult cancer cases (ages ≥18) per year was associated with higher odds (1.81, confidence interval 1.02–3.23) of geriatrician availability. Other multidisciplinary care professionals that could support GA were variably available onsite: social worker (84%), nurse navigator (81%), pharmacist (77%), dietician (71%), rehabilitative medicine (57%), psychologist (42%), and psychiatrist (37%). Conclusion Only a third of community oncology practices have access to a geriatrician within their group and only 5% of community sites have access within the oncology clinic. Use of primarily self-administered GA tools that direct referrals to available services may be an effective implementation strategy for guideline-based care. Implications for Practice Only a minority of community oncology practices in the U.S. have access to geriatric specialty care. Developing models of care that use patient-reported measures and/or other geriatric screening tools to assess and guide interventions in older adults, rather than geriatric consultations, are likely the most practical methods to improve the care of this vulnerable population.

【 授权许可】

CC BY|CC BY-NC