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

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

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  • NSTL
  • Wiley
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.

Cancer care deliveryAgingGeriatric oncologyCommunity oncologyGeriatric assessment

Klepin, Heidi D.、Williams, Grant R.、Weaver, Kathryn E.、Lesser, Glenn J.、Dressler, Emily、Winkfield, Karen M.、Neuman, Heather B.、Kazak, Anne E.、Carlos, Ruth、Gansauer, Lucy J.、Kamen, Charles S.、Unger, Joseph M.、Mohile, Supriya G.

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Wake Forest Sch Med, Wake Forest Baptist Comprehens Canc Ctr, Winston Salem, NC 27101 USA

Univ Alabama Birmingham, ONeal Comprehens Canc Ctr, Birmingham, AL USA

Univ Wisconsin, Div Surg Oncol, Madison, WI USA

Nemours Childrens Hlth Syst, Wilmington, DE USA

Univ Michigan, Ctr Comprehens Canc, Ann Arbor, MI 48109 USA

Spartanburg Reg Med Ctr, Spartanburg, SC USA

Univ Rochester, James Wilmot Canc Inst, Rochester, NY USA

Univ Washington, Fred Hutchinson Canc Res Ctr, Seattle, WA 98195 USA

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2020

10.1634/theoncologist.2020-0189

The oncologist

The oncologist

ISSN：1083-7159
年,卷(期)：2020.25(12)
  • 14
  • 43