Implementation of a Multi-Disciplinary Geriatric Oncology Clinic in Toronto, Canada.

Older adults with cancer tend to face more complex health needs than their younger counterparts. Patients > 65 years of age are recommended for comprehensive geriatric assessment (CGA) to capture and address age-related vulnerabilities. Access to geriatrics services is limited, and our baseline audit of geriatric referrals in 2019 from the cancer program revealed that only 30% of patients referred received a CGA.

Supporting older adults with cancer and their support person through geriatric assessment and remote exercise and education: The SOAR study protocol.

Introduction: Frail older adults receiving cancer treatment are at heightened risk of adverse outcomes. Despite the known benefits of exercise during cancer treatment to improve well-being, few exercise studies focus on frail older adults receiving cancer treatment and their support person. Geriatric assessment (GA) is often recommended prior to the start of treatment for frail adults with cancer, but combining the GA with a planned exercise regimen remains unexplored.

Interventions to improve health care provider implementation and patient adherence of patients to recommendations on geriatric assessment and management in older adults: A scoping review protocol.

The world population is aging. Comprehensive Geriatric assessment (CGA) has been proven to improve the well-being of older adults. However, evidence suggests not all clinicians implement these recommendations in their practice; nor do all patients adhere to them.

Improving Care for Older Adults with Cancer in Canada: A Call to Action.

Most patients diagnosed with and dying from cancer in Canada are older adults, with aging contributing to the large projected growth in cancer incidence. Older adults with cancer have unique needs, and on a global scale increasing efforts have been made to address recognized gaps in their cancer care. However, in Canada, geriatric oncology remains a new and developing field.

Implementing geriatric assessment and management for older Canadians with cancer: Adherence to and satisfaction with the intervention, results of the 5C study.

Introduction: Geriatric assessment and management (GAM) is recommended by professional organizations and recently several randomized controlled trials (RCTs) demonstrated benefits in multiple health outcomes. GAM typically leads to one or more recommendations for the older adult on how to optimize their health. However, little is known about how well recommendations are adhered to.

Impact of Geriatric Assessment and Management on Quality of Life, Unplanned Hospitalizations, Toxicity, and Survival for Older Adults With Cancer: The Randomized 5C Trial.

Purpose: American Society of Clinical Oncology recommends that older adults with cancer being considered for chemotherapy receive geriatric assessment (GA) and management (GAM), but few randomized controlled trials have examined its impact on quality of life (QOL).

Patients And Methods: The 5C study was a two-group parallel 1:1 single-blind multicenter randomized controlled trial of GAM for 6 months versus usual oncologic care. Eligible patients were age 70+ years, diagnosed with a solid tumor, lymphoma, or myeloma, referred for first-/second-line chemotherapy or immunotherapy or targeted therapy, and had an Eastern Cooperative Oncology Group performance status of 0-2.

The development of an electronic geriatric assessment tool: Comprehensive health assessment for my plan (CHAMP).

Introduction: Geriatric assessment (GA) provides information on key health domains of older adults and is recommended to help inform cancer treatment decisions and cancer care. However, GA is not feasible in many health institutions due to lack of geriatric staff and/or resources. To increase accessibility to GA and improve treatment decision making for older adults with cancer (≥65 years), we developed a self-reported, electronic geriatric assessment tool: Comprehensive Assessment for My Plan (CHAMP).

Retrospective analysis of VES-13 questionnaires in the Senior Women's Breast Cancer Clinic at Sunnybrook Health Sciences, Toronto, Ontario, Canada.

Purpose: Vulnerable Elder Survey (VES-13) is a screening tool used in assessing older vulnerable patients at risk of functional decline. We sought to evaluate how VES-13 tool would impact oncologist referral pattern to geriatricians as our primary outcome. We also sought to better understand how VES-13 scores impacted referral to additional services (allied healthcare), and modification to oncological treatment.

Development and Testing of an Adjuvant Radiotherapy Decision Aid for Older Women Diagnosed with Stage I Breast Cancer: A Pilot Study.

Background Whole breast irradiation therapy (WBRT), accelerated partial breast irradiation (APBI), and omission of radiotherapy (ORT) are options for women aged 65 years and older with low-risk breast cancer post lumpectomy. Aim The aim of the study was to develop and pilot a decision aid pamphlet (DA), among women aged 65 years and older with low-risk breast cancer and who were undergoing or had undergone WBRT, to ensure they were fully informed about the different options for radiation treatment following lumpectomy. Methods We piloted the decision aid with 40 participants, women aged 65-86 years with low-risk breast cancer and who had undergone or were undergoing WBRT.

Gait Speed vs. VES-13: A Pilot Study Comparing Screening Tools to Determine the Need for a Comprehensive Geriatric Assessment in Senior Women with Breast Cancer.

Background/objectives: Patients aged 70 years and older may be suboptimally treated with cancer therapy because of the lack of clinical trial data in this population. The Comprehensive Geriatric Assessment can be time consuming, and access to geriatricians is limited. This study aims to determine whether gait speed (GS) analysis is equivalent to the widely accepted Vulnerable Elders Survey 13 (VES-13) in identifying vulnerable or frail patients in need of a Comprehensive Geriatric Assessment.

Clinical and Cost-effectiveness of a Comprehensive geriatric assessment and management for Canadian elders with Cancer-the 5C study: a study protocol for a randomised controlled phase III trial.

Introduction: Geriatric assessment and management is recommended for older adults with cancer referred for chemotherapy but no randomised controlled trial has been completed of this intervention in the oncology setting.

Trial Design: A two-group parallel single blind multi-centre randomised trial with a companion trial-based economic evaluation from both payer and societal perspectives with process evaluation.

Participants: A total of 350 participants aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, who speak English/French, have an Eastern Collaborative Oncology Group Performance Status 0-2 will be recruited.

National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology.

Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents' geriatric oncology learning needs.

The Perceptions and Expectations of Older Women in the Establishment of the Senior Women's Breast Cancer Clinic (SWBCC): a Needs Assessment Study.

This study explored older women's perceptions and expectations of the prospective Senior Women's Breast Cancer Clinic (SWBCC) at Sunnybrook Odette Cancer Centre (SOCC) in Toronto, Ontario, Canada. In our previous studies, older breast cancer patients had expressed a greater need for informational, decisional, and post-treatment support. This study also assessed women's perspectives on the involvement of geriatricians and incorporation of geriatric assessment in their cancer care.

Towards an optimal multidisciplinary approach to breast cancer treatment for older women.

The treatment of breast cancer presents specifc concerns that are unique to the needs of older female patients. While treatment of early breast cancer does not vary greatly with age, the optimal management of older women with breast cancer often requires complex interdisciplinary supportive care due to multiple comorbidities. This article reviews optimal approaches to breast cancer in women 65 years and older from an interdisciplinary perspective.

Application of a trigger tool in near real time to inform quality improvement activities: a prospective study in a general medicine ward.

Background: Retrospective record review using trigger tools remains the most widely used method for measuring adverse events (AEs) to identify targets for improvement and measure temporal trends. However, medical records often contain limited information about factors contributing to AEs. We implemented an augmented trigger tool that supplemented record review with debriefing front-line staff to obtain details not included in the medical record.

Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial.

Importance: Hospital readmissions are common and costly, and no single intervention or bundle of interventions has reliably reduced readmissions. Virtual wards, which use elements of hospital care in the community, have the potential to reduce readmissions, but have not yet been rigorously evaluated.

Objective: To determine whether a virtual ward-a model of care that uses some of the systems of a hospital ward to provide interprofessional care for community-dwelling patients-can reduce the risk of readmission in patients at high risk of readmission or death when being discharged from hospital.

Real-time automated paging and decision support for critical laboratory abnormalities.

Background: For patients with critical laboratory abnormalities, timely clinical alerts with decision support could improve management and reduce adverse events.

Methods: The authors developed a real-time clinical alerting system for critical laboratory abnormalities. The system sent alerts to physicians as text messages to a smartphone or alphanumeric pager.