Table 1 Possible models of care in geriatric oncology and their advantages and challenges
From: Geriatric assessment for older people with cancer: policy recommendations
Model of care | Pathway | Advantages | Challenges |
|---|---|---|---|
Consultative | Oncologist refers patient Reasons: GA and intervention recommendations, treatment recommendations GA performed by geriatrician and multidisciplinary team (consisting of allied health professionals and geriatric experts) | Geriatric/geriatric oncology expertise Recommendations from a multidisciplinary team | Physician buy-in need to refer One time visit No longitudinal follow-up Interventions often left to treating team Long visits: Limited no. of patients per clinic session Multiple visits and physicians for patients Need to maintain good communication in the team |
Shared care | Oncologist refers patient Reasons: GA and intervention recommendations, treatment recommendations GA performed by geriatrician and/geriatric oncologist and multidisciplinary team Interdisciplinary meeting to review the results and care plan Geriatric oncology team collaborates with treating oncologist and provides concurrent care across the disease trajectory | Collaborative care through disease trajectory Geriatric/geriatric oncology expertise Interventions and multidisciplinary recommendations can be implemented over time | Physician buy-in needed to refer Visits may not be centralized Shortage of geriatricians Extra visits for the patient |
Comprehensive | Geriatric oncologist is the treating oncologist throughout the patient’s disease trajectory No need for additional referrals GA performed Results and recommendations are reviewed with the patients Referrals to the multidisciplinary team | Geriatric oncology expertise throughout the treatment trajectory Convenience: One-stop shop (geriatrics and oncology) | Shortage of geriatric oncologists Complex patient population (limited no. of patients can be seen) |
Resource limited alternatives | Option 1 Use a frailty screening tool to assess who needs a GA or who is vulnerable | Less time consuming For the use of geriatric screening tools no geriatric expertise necessary Less GAs need to be performed | Challenging to select the optimal screening tool and decide accurate cut-offs Screening tools are less accurate in identifying who may benefit from geriatric interventions, over- and under-treatment may be a consequence |
Option 2—Let other health care professionals without geriatric expertise perform a GA and use an existing intervention protocol to implement non-oncologic interventions | Can be used when there is a lack of geriatric expertise No additional time is required from the oncology team | Result of GA is not taken into account in oncologic treatment plan, so less effect on outcomes is expected |