Exploring Clinical Decision Making in the Treatment of Cancer in Older Patients


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Helen Beck1,Emlyn Samuel1,Kerry Allen2
1Cancer Research UK,2University of Birmingham

Abstract

Background

More than a third of cancer diagnoses occur in people over the age of 75. Survival rates for several cancer types are lower in the UK compared with other countries. There is growing evidence to suggest that under-treatment of older patients in the UK may be contributing to poor outcomes.

Cancer Research UK have commissioned the University of Birmingham to better understand clinical decision making relating to older cancer patients across the UK. In particular, whether decisions are made based on appropriate assessments, or whether assumptions based on age are acting as a barrier to access.

Method

The UK wide study commenced February and publishes November 2016. Specific methods are:

  • Rapid evidence assessment of literature;
  • Semi-structured interviews with national stakeholders;
  • National online survey of primary care and Multidisciplinary Team (MDT) clinical leads to understand assessment practices;
  • 150 semi-structured interviews across eight case study sites with MDT participants and GP cancer leads, including active observation of MDTs;
  • National online patients’ survey and sessions with older patients to test findings.

Results

We will present full study results (available in September). Early findings indicate:

  •  Information from the Comprehensive Geriatric Assessment is not appearing in MDT meetings. This may be because it is not being carried out in a timely way.
  • Cancer Nurse Specialists can play an important role at MDT meetings representing the older patient.
  • Greater involvement of primary care professionals may help to ensure appropriate patient information reaches the MDT. The development of new integrated approaches appear promising.
  • For older patients, personal history, local access to services, care and living arrangements can be central to their decision about treatment.

Conclusion

The study will develop recommendations for any changes to practice. It will also help inform the potential future pilot of a comprehensive care pathway for older patients as recommended by the Cancer Strategy (recommendation 41).