Transcript of "Jeanette Prouse, Geriatric Oncology Nurse, Royal Adelaide ..."
Geriatric Oncology: the role
of the specialist nurse
Janette Prouse MNSc
Royal Adelaide Hospital
> The Royal Adelaide Hospital Cancer Centre (RAHCC)
established the first geriatric oncology program in
Australia that specifically caters for patients ≥70 years
age with cancer.
> There are currently two geriatric oncology nurses
> Janette Prouse RN – 1.0 FTE
> Wendy McGahey EN – 0.6 FTE
The critical functions of the RAHCC geriatric oncology registered
nurse is to ensure that a coordinated response is implemented to
optimise the cancer journey of the older adult.
Ideally this requires the nurse to:
> Hold a relevant postgraduate qualification in cancer nursing
> Possess extensive clinical experience
> Demonstrate effective communication skills
> Be an active participant in multidisciplinary teams
> Participate in ongoing quality improvements of their practice
> Contribute to research activities
The role of the geriatric oncology nurse
has three key components:
> Clinical practice
Clinical practice - duties
> Mail out the self administered questionnaire to all new medical
oncology patients ≥ 70 years.
> Prepare assessment questionnaire and scoring sheet for the
weekly multidisciplinary team meeting.
> Coordinate weekly multidisciplinary team meeting – casenotes,
clinical summaries, IT etc
> Actively participate in MDT
> Contact each patient to discussed the outcomes of the MDT and
whether activation of indicated supportive services is warranted
Monitoring and follow-up of patients is recognised as
the cornerstone of the Geriatric Oncology Program.
Follow-up of this group of patients is a monumental
task therefore, careful management is crucial.
Currently our aim is to visit patients during each
medical oncology visit or if having chemotherapy the
beginning of each cycle (2-3 weekly).
Questions that remain in debate are:
> How often should each patient be contacted/visited?
> When does a patient become ‘inactive’?
> Should or when do we reassess patients?
Before, midway and/or on completion of active treatment?
At fixed points of time?
72 year old lady from Kapunda with metastatic melanoma
History of Cancer:
> Primary melanoma left foot 2005. Had further groin
dissection in August 2005
> 2008 - repeat left groin pelvic dissection for recurrence
> 2009 - multiple excisions of melanoma deposits and
radiotherapy to the neck and also to the right arm
> Now has further subcutaneous nodules which are not
suitable for resection
Past Medical History:
> Macular degeneration
January 2009 March 2010
Charlson score 0 0
Memory No concern No concern
Vision No concern Impaired
Nutrition Nil weight loss Nil weight loss
Falls Nil Nil
IADLs No concern (7/21) No concern (10/21)
Physical function Impairment (14/30) Severe impairment (28/30)
KPS 100% 60%
Social support Nil concern Nil concern
Psychological support No concern (10/45) No concern (13/45)
Distress scale 0/10 7/10
Pain scale 2/10 5/10
Exhaustion 2/8 4/8
Community services nil nil
Category Fit Vulnerable
Referrals None Palliative Care, Clinical Psychology (refused),
Clinical Practice – data management
Responsible for entering all data (excel sheet) concerning the
completed questionnaire and scoring sheets; referrals post
Currently assisting with the development/modification of an
access data base used by Clinical Practice Consultants in
RAH ie breast care nurse, gynaeoncology nurse and the
colorectal nurse. This will aid the follow up of patients by
detailing demographics, treatments, referral patterns,
encounters, complications etc.
Investigating the possibility of modifying a database developed
as an initiative by the Statewide Cancer Clinical Network for
The geriatric oncology nurse requires to initiate
education amongst oncology nurses in formal and
informal settings within the RAH and at national and
There is a need for oncology nurses to understand
what geriatric oncology practice involves such as
understanding why the care of young adults differs to
> Clinical Oncological Society of Australia Annual Scientific
Meeting: (Gold Coast, 2009):Invited speaker - Geriatric
assessment: the role of the specialist nurse
> The International Society of Geriatric Oncology - 10th SIOG
Meeting Berlin (Germany 2009) -poster presentation: Janette
Prouse, Nimit Singhal, Jude Lees, Sigourney Troyano, Melissa
Bond, Robert Prowse. Acceptance of supportive care
interventions by older patients with cancer: an audit
> Oncology Graduate Diploma - presentation (2009): Invited
speaker - “Cancer and the older person”
> In-service education discussing nurse-sensitive issues of older
cancer adults RAHCC
Education – future directions
> Possibility of stand alone nursing short course 1-2
> Chemotherapy short course (RAH) additional tutorials
in established course
• Tutorials covering topics
Introduction into age-related physiological changes
Aspects of health assessment – impact of comorbidities,
functional reserve and social network deficits
Principles of geriatric assessment
Education – future directions
Establishment of a advance traineeship for geriatric
oncology nurse practitioners.
This would require:
> An appropriate level of professional support
> Investigation into the sustainability of the role
> Needs assessment
Nursing research requires to provide informative data
for understanding the effects of nursing therapeutics.
This then would link the process of care delivery with
Oncology nursing research often focuses on:
• Experience of wellness and illness
• Clinical therapeutics under the control of nurses
• Systems designed to deliver cancer care
• Outcomes directly attributed to nursing interventions
Research – nursing
The effects of a Geriatric Oncology pre-chemotherapy education
on the ability to recall potential side effects and their related self
care strategies in the older cancer patient: A Randomised
> Prior to chemotherapy an interventional nurse will explain and
discuss the chemotherapy treatment, potential side effects, self
care strategies and treatment frequency in a quite environment.
> Issues of concern for the patient or attending support person can
be raised and incorporated in the education session. A completed
Geriatric Assessment Questionnaire will be utilised as a source of
additional information for the nurse.
> Singhal N, Prouse J, Lees J, Peterson M, Boyce A,
Willoughby M, Guthrie S, Garbett Smith C, Prowse R.
Geriatric Oncology program at Royal Adelaide
Hospital- Analysis of first 100 patients. Asia-Pac J Clin
Oncol 2008;4(suppl 2):A412.
It is the vision of our team to optimise the
journey for older people affected by cancer by
means of supplying timely and appropriate
interventions using a proactive approach.
The geriatric oncology service aims to assist
patients and clinicians to make insightful and
collaborative treatment decisions through the
philosophy of ‘screening for all and intervention
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