Robert J Prowse, Senior Consultant Geriatrician, Royal ...

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Robert J Prowse, Senior Consultant Geriatrician, Royal ...

  1. 1. CANCER AND OLDER PEOPLE : Establishing the First Geriatric Oncology Service in Australia Robert J Prowse Senior Consultant Geriatrician Royal Adelaide Hospital
  2. 2. Geriatricians & Oncology  Oncology not currently an area of interest to Geriatricians  Primary referrers to Oncologists (surgeons, general physicians, GPs) won’t send even frail old patients with cancer to Geriatricians  Geriatricians won’t be seeing cancer via this avenue
  3. 3. What could geriatricians bring to cancer care?  Knowledge of pharmacology  Management of poly-pharmacy  Knowledge of complex co-morbidity  Understanding of effects of cognitive impairment
  4. 4. Role of the Geriatrician  Orthogeriatrics  Liaison to:  psychogeriatric services  emergency departments  Oncogeriatrics
  5. 5. Geriatrician's Patients with Cancer  Will often be frail, with complex co- morbidities, including cognitive impairment  Geriatricians will decide on suitability for cancer care, resulting in:  no referral to oncology  reasonably competent palliative care  palliative care referral if required  facilitated residential care placement
  6. 6. Geriatrics and Cancer Services  Knowledge in fields which don’t closely communicate is likely to have advanced surprisingly  Demography suggests closer collaboration by all related specialties would be desirable
  7. 7. Geriatricians with Cancer Patients  Are unlikely to be aware of changes in outcomes with particular cancers  Should be able to recognize patients in whom investigation and treatment may be worthwhile  Will be aware of ageist attitudes
  8. 8. Geriatricians and Oncologists  Geriatricians will continue to make many decisions about patients with cancer within their own teams  Oncological advice should be sought more often  Are cancer services:  open to such referral?  resourced adequately?
  9. 9. Oncogeriatric Services  Oncologists increasingly recognised need for specialist geriatric input into older cancer patients  Training oncologists in aspects of Geriatric Medicine (US, France)  Geriatricians working within multidisciplinary teams in Geriatric Oncology (Australia, Belgium)
  10. 10. Oncogeriatric Services  Are there enough geriatricians and trainees to conduct developing services?  Is there sufficient interest?  Is there sufficient funding?  Is there enough time?
  11. 11. Australian Directions  Clinical Oncology Society Australia (COSA) Special Interest Group in Cancer in Older People  Chair: Christopher Steer  Geriatrician member  Workshops  April 2008  November 2009
  12. 12. Oncogeriatrics Internationally  National Cancer Institute centres of geriatric oncology in France  Geriatric Oncology working party in Germany clinical trials  United States  Florida – Moffitt Senior Adult Oncology Program ( L Balducci)  International Society of Geriatric Oncology (SIOG)
  13. 13. Current Australian Directions  3 advanced trainees undergoing joint oncology / geriatrics training  One currently working in Adelaide
  14. 14. Oncogeriatric Services in Australia  Pioneer Service began in Adelaide 2006  Nimit Singhal  Jeanette Prouse  Over 400 patients now been assessed  Funding established:  RN Geriatric Oncology Nurse  EN  Occupational Therapist  Dietitian

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