Multidisciplinary treatment planning in elderly patients with cancer: A prospective observational study

Abstract

Background: Elderly cancer patients are a special population, and their management should include specialists in oncology, geriatrics, palliative care, and social work. Based on this approach, we designed a multidisciplinary care model (MCM) and prospectively assessed its results. Objectives: To evaluate the applicability of the MCM, to describe the geriatric features of our sample, and to assess the impact of the MCM on treatment choices. Methods: Patients older than 69 years of age with solid tumours were included. The MCM included the following decision algorithm: Patients with an unequivocal condition of frailty, assessed in the corresponding tumor committee, were directly referred to the palliative care team (Group A). In the other cases (Group B), patients over age 79 years underwent the Comprehensive Geriatric Assessment (CGA) and patients aged between 70 and 79 years completed a frailty test. If the frailty test was positive, CGA was also performed. Results: 295 patients meeting the inclusion criteria were identifed during one year. 186 (63%) were included in the MCM. A total of 66 CGA were performed. CGA modifed the therapeutic plan in 5 patients older than 80 (13.8%), and in 2 septuagenarian patients (6.6%). Limitations: This study was designed to evaluate the feasibility of a multidisciplinary approach in geriatric oncology patients in a real clinical setting. Therefore, some variables were not fully controlled in the design, such as the willingness of different specialists to refer their patients to the model. Conclusions: MCM in elderly oncology patients is feasible in a general hospital, although several reasons often hinder patient recruitment for this kind of program. CGA can modify the therapeutic plan, especially in the octogenarian population.