|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 793-794
To bridge the last-mile gap
Department of Geriatric Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
|Date of Submission||27-Oct-2021|
|Date of Decision||01-Nov-2021|
|Date of Acceptance||09-Nov-2021|
|Date of Web Publication||29-Dec-2021|
Department of Geriatric Medicine, Room No 3, 1st Floor, Screening OPD Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gunasekaran V. To bridge the last-mile gap. Cancer Res Stat Treat 2021;4:793-4
In the last issue of Cancer Research, Statistics, and Treatment, Noronha et al. reported the results of a survey of oncologists' perception of the geriatric assessment (GA) domains and outcomes in older patients with cancer. This study brings out some important and concerning findings. The majority of the participants agreed that the following assessments are essential in GA: comorbidities, use of potentially inappropriate medicines, social support, drug interactions, polypharmacy, quality of life, functionality, falls, nutrition, and cognition. About 93.6% felt that the assessment of psychological status is important. Among the outcomes, 36.7% thought that performing a GA would improve the overall survival, quality of life, and toxicity, whereas 21.7% and 28.9% thought that performing a GA would improve the quality of life with and without a decrease in toxicity, respectively. Although the participants' perception of the outcomes were divided, the vast majority (90%) believed that GA could improve the patient's quality of life.
The most worrying finding of this survey is that only 7.2% of the participants either performed or referred at least 50% or more of their older patients with cancer for a GA. About 41.5% never performed or referred a patient for GA, and 32.3% performed or referred <10% of their patients for GA. The American Society of Clinical Oncology recommends GA for all adults aged 65 years and above, who are undergoing chemotherapy. This study underlines the stark contrast with the recommendation and perception of the importance of GA among oncologists and the actual practice. Although this survey did not report the reasons for the respondents to not perform GA, other studies have shown that the gap is often due to the lack of time, staff, or knowledge and training., The study has not reported country-specific practices, but 87% of the respondents were from India. The lack of time among oncologists and lack of trained geriatric workforce in a resource-limited country like India can lead to the last-mile gap in the care of older patients with cancer. About 96% of the respondents felt that a formal GA training should be part of the oncology training programs. However, the questionnaire used in the survey did not assess whether lack of training was a cause for not performing GA. Even if GA were to become a part of the oncology training, the time required to perform a GA may impede its proper utilization in clinical practice.
A stop-gap solution to this issue could be to follow a two-step approach for GA. Appropriate patient selection for GA in a resource-limited setting can help bridge the gap between recommendation and practice. Robust older adults with preserved functionality are less likely to benefit from GA. So is the case with moribund or very sick older adults where a focused assessment and palliative care would be the right approach. Identifying older patients with cancer who would benefit from GA by using screening scales like G8 orVulnerable Elders Survey-13 (VES-13) is the way forward in our country, at least in the short term. The future lies in using electronic GA, where electronic health records coupled with patient-reported GA can provide personalized care pathways for each older patient. To improve the quality of life and care of older adults with cancer, we should focus on training the workforce, developing quick assessment tools, using artificial intelligence in GA, incorporating GA in treatment guidelines and practice, and prioritizing personalized care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Oncologists' perceptions of the need for assessing individual domains in the geriatric assessment and worthwhile outcomes in treating older patients with cancer: A questionnaire-based survey. Cancer Res Stat Treat 2021;4:492-8. [Full text]
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