|GERIATRIC ONCOLOGY SECTION
|Year : 2019 | Volume
| Issue : 2 | Page : 232-236
Survey for geriatric assessment in practicing oncologists in India
Vanita Noronha, Vikas Talreja, Amit Joshi, Vijay Patil, Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
|Date of Web Publication||20-Dec-2019|
Department of Medical Oncology, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra; Homi Bhabha National Institute (HBNI), Mumbai
Source of Support: None, Conflict of Interest: None
Introduction: Geriatric oncology (GO) is a medicine discipline that deals with the diagnosis, treatment, and management of older patients with cancer.
Objectives: The objective of this study was to describe the knowledge and awareness regarding the management of geriatric cancer patients through an online survey of oncologists in India.
Materials and Methods: A detailed descriptive survey was sent to several practicing oncologists using emails and social media.
Results: Between March 2019 and June 2019, 100 answers were collected. Even though 99% of the respondents were treating geriatric patients in their daily clinical practice, 44% lacked awareness for any guideline for geriatric care. Majority of the respondents (70%) claimed not to apply any special management practices using specific tools for every geriatric patient. Overall, there was agreement that the discipline of GO afforded certain potential advantages. Lack of time, training, resources, awareness, and staff were cited as the most common reasons preventing the routine implementation of geriatric assessment in clinical practice.
Conclusions: From this nationwide survey, we conclude that there is a perception of the need for training in GO as there is no defined care structure for older patients with cancer.
Keywords: ASCO geriatric guidelines, geriatric oncology survey, Indian geriatric oncology, Indian survey
|How to cite this article:|
Noronha V, Talreja V, Joshi A, Patil V, Prabhash K. Survey for geriatric assessment in practicing oncologists in India. Cancer Res Stat Treat 2019;2:232-6
|How to cite this URL:|
Noronha V, Talreja V, Joshi A, Patil V, Prabhash K. Survey for geriatric assessment in practicing oncologists in India. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Feb 22];2:232-6. Available from: http://www.crstonline.com/text.asp?2019/2/2/232/273712
| Introduction|| |
Among the fastest-growing segment of the population is the geriatric population. According to the International Aging Reports, the older population, which comprised 8.5% of the total population in 2015, will increase to 12% in 2030 and to 16.7% in 2050. More than 60% of patients who are newly diagnosed with cancer are aged 65 years or older. Older adults are heterogeneous and have varying degrees of functional impairments, comorbidities, psychiatric and cognitive impairments, and social support systems. It is challenging to apply evidence-based medicine to this population as they are not well represented in clinical trials and those who are included are a section of fit older adults. All of this impacts the morbidity and mortality in older patients due to either over- or under-treatment. For a descriptive evaluation of the health status, a comprehensive geriatric assessment is advised. Although recommended by the International Society of Geriatric Oncology (SIOG) and the National Comprehensive Cancer Network (NCCN), the application of geriatric assessment is not routinely implemented in oncology practice as it is perceived to be a resource- and time-consuming., Nowadays, cancer-specific geriatric assessment tools have been built that can gather a wealth of information without the time commitment and burden on patients and caregivers., There is limited information in India on experiences and views of oncologists on geriatric oncology (GO). We, therefore, conducted this survey to explore perceptions and barriers to the incorporation of geriatric screening tools in routine oncology practice.
| Materials and Methods|| |
This was an anonymized cross-sectional nationwide survey. The online survey consisted of 12 questions for the management of older patients with cancer based on a literature [Table 1] search and expert opinions, which included the respondents'.
- Oncology practice environment and target patient population
- Challenges and treatment decision-making factors
- Benefits and barriers to the implementation of geriatric tools in daily practice.
The draft of the questionnaire was intentionally made simple and quick for busy physicians for maximum participation in a Google form (Google, Mountain View, CA, USA). The survey could not be completed twice by the same person as it was case-sensitive. All responses were linked to the online form in a Google spreadsheet.
Qualitative variables were reported as numbers (N) and percentages. Statistical analyses were performed using the Chi-square or Fisher's exact test. Statistical analyses were conducted using the IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.).
| Results|| |
Of 193 eligible participants, 100 responses were obtained. The response rate of the survey was 51.8%; of 100 respondents, 70 were medical oncologists, 19 were trainees (resident/fellow), 8 were surgical oncologists, 2 were palliative medicine specialists, and 1 was a radiation oncologist [Table 2]. Sixty-four percent of respondents were in an academic center, whereas 35% were involved in a community- or hospital-based private practice. The first question referred to the number of geriatric patients seen by the survey participant in his/her clinic. Eighty-seven percent responded that he/she was seeing more than 10 patients/week. When asked whether they currently provide clinical care for adult patients with cancer, 99% acknowledged the same. When asked about their specialty of cancer type, the majority (61%) said that they are generalists (seeing all cancer types in their practice). In [Figure 1], the distribution of the most frequent cancer disease sites (maximum of three) was illustrated. When asked about the ASCO GO Guidelines Practical Assessment and Management of Vulnerabilities in older patients receiving chemotherapy, 44% were unaware of the same. The barriers to the practice of geriatric assessment in daily practice included lack of time, staff, awareness, resources, space, and uncertainty about the tools to use for assessment [Figure 2] were cited as the most common reasons, [Figure 3] whereas only 4% believed that there was a limited clinical benefit for such assessment.
|Figure 1: What are the most frequent cancer disease sites you see in clinic? Please select no more than three answers|
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|Figure 2: In the past 12 months, have you used validated tools to assess the following domains in patients 65 years and older? Please check all that apply and list ant additional tools you may use in other|
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|Figure 3: Barriers in clinical practice for the application of Geriatric assessment|
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| Discussion|| |
Our survey was designed to assess the true situation of knowledge and practice in India with respect to the management of geriatric cancer patients. In our survey, in 100 Indian oncologists, 87% of whom saw ten or more geriatric cancer patients per week, 51% did not routinely perform a comprehensive geriatric assessment, of which 9% performed a geriatric assessment either rarely or never. Seventy percent used their clinical judgment or “intuition” to help decide the management plan. Only 9% used validated tools.
Studies have been published in the international literature on this subject, however; none of them were based on the data from India. The survey results are similar to other international surveys where the vast majority (75%–95%) of cancer specialists believe that geriatric assessment is beneficial for better care for patients.,,,, A German survey found that while 95% thought that geriatric assessment was meaningful, 30% thought it was not feasible to practice. Similarly, in a Singaporean survey, 28% questioned the application of such a service. A recent Belgian survey identified that while a substantial proportion of patients receive geriatric assessment and have recommendations implemented, the availability and incorporation of geriatric assessment into multidisciplinary discussions and treatment decisions occur <20% of the time. In our study, time restraints, lack of clinical staff, lack of awareness, polypharmacy, poor functional status, and treatment toxicity were the most commonly identified challenges when caring for older patients with cancer, similar to those identified in surveys done in 2006 in Canada and Singapore.,
Ours is the first survey to ascertain the perception of GO among medical oncologists in India. In line with Europe and the rest of the world, India suffers a clear delay from transferring recommendations into oncology practice for geriatric assessment and the use of validated tools in the management of the geriatric cancer patients., Ideally, collaboration with the oncologist, geriatrician, physician, medical staff, and caregivers through the provision of GO must address the barriers for routine implementation in practice for every older patient and guide future research. This survey has identified the desire and need among Indian oncologists for the incorporation of geriatric training into oncology training and evidence-based Indian geriatric recommendations.
There are various limitations of our study. The low response rate may also reflect an ambivalence toward GO among oncologists, highlighting the need for ongoing awareness-raising and generation of supporting evidence. The design and provision of GO services must address the barriers identified in this research, in particular, the availability of geriatric assessment (GA) and geriatric expertise in a timely manner. On the contrary, it might be confounded by responder bias with those with interest in GO might be overrepresented in the sample.
The preferred model of geriatric care is evidence-driven locally tailored as per the merits of different models of care and expertise and funding for GA-driven interventions in the Indian population.
| Conclusions|| |
This survey underlines the need for a comprehensive geriatric assessment tool in India for screening, evaluation, management, and education in settings of limited resources and time in oncology practice.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Berger NA, Savvides P, Koroukian SM, Kahana EF, Deimling GT, Rose JH, et al
. Cancer in the elderly. Trans Am Clin Climatol Assoc 2006;117:147-55.
VanderWalde N, Jagsi R, Dotan E, Baumgartner J, Browner IS, Burhenn P, et al
. NCCN Guidelines Insights: Older Adult Oncology, Version 2.2016. J Natl Compr Canc Netw 2016;14:1357-70.
Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al
. Use of comprehensive geriatric assessment in older cancer patients: Recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005;55:241-52.
Overcash JA, Beckstead J, Extermann M, Cobb S. The abbreviated comprehensive geriatric assessment (aCGA): A retrospective analysis. Crit Rev Oncol Hematol 2005;54:129-36.
Hamaker ME, Wildes TM, Rostoft S. Time to stop saying geriatric assessment is too time consuming. J Clin Oncol 2017;35:2871-4.
Jonker JM, Smorenburg CH, Schiphorst AH, van Rixtel B, Portielje JE, Hamaker ME. Geriatric oncology in the netherlands: A survey of medical oncology specialists and oncology nursing specialists. Eur J Cancer Care (Engl) 2014;23:803-10.
Pang A, Ho S, Lee SC. Cancer physicians' attitude towards treatment of the elderly cancer patient in a developed Asian country. BMC Geriatr 2013;13:35.
Honecker F, Wedding U, Huschens S, Bokemeyer C. Incorporation of geriatric assessment into oncology practive: Views and attitudes of physicians participating in the IN-GHO registry. J Clin Oncol 2011;29 Suppl 15:e19607-07.
Wan-Chow-Wah D, Monette J, Monette M, Sourial N, Retornaz F, Batist G, et al
. Difficulties in decision making regarding chemotherapy for older cancer patients: A census of cancer physicians. Crit Rev Oncol Hematol 2011;78:45-58.
Kenis C, Heeren P, Decoster L, Van Puyvelde K, Conings G, Cornelis F, et al
. A belgian survey on geriatric assessment in oncology focusing on large-scale implementation and related barriers and facilitators. J Nutr Health Aging 2016;20:60-70.
Soto-Perez-de-Celis E, de Glas NA, Hsu T, Kanesvaran R, Steer C, Navarrete-Reyes AP, et al
. Global geriatric oncology: Achievements and challenges. J Geriatr Oncol 2017;8:374-86.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]