Models of clinical care delivery for geriatric oncology in Canada and the United States: A survey of geriatric oncology care providers

Abstract

Background: Geriatric assessment (GA) can help improve patient care and outcomes. There are increasing numbers of centres in Canada and the United States (U.S.) which provide geriatric oncology services, but the distribution and structure of these clinics is unclear. This study sought to identify and describe outpatient geriatric oncology clinics in Canada and the U.S.

Materials and methods: A 30-question survey was administered electronically to clinics identified by the authors, through a search of the internet and from members of geriatric oncology community of practices in Canada and the U.S. Additional clinics were identified via a snowball method. Descriptive statistics were used. An exploratory analysis of factors associated with higher volumes of patients seen was done using a two sample t-test and one-way Analysis of Variance (ANOVA) for categorical variables and simple linear regression for continuous variables.

Results: Nineteen clinics (5 in Canada, 14 in U.S.) responded. Median duration in operation was 5 years (range < 1 to 25 years). More than a third (36.8%) were run by a geriatric oncologist alone, 36.8% had input from both geriatrics and oncology, while 21.1% had access to only one of the disciplines. The majority of clinics had nursing, social work and pharmacy involvement, with fewer having physiotherapy and dieticians. Just over half (53%) had an age cut-off for referral to their clinic. Fitness for treatment was the most common reason for referral. Clinics saw a median of 188 consults per year (range 0-1000). Clinics which have been operating longer (p = 0.002), those that took less time to complete a GA (p = 0.03), and those in which individual components of the GA were assessed by each discipline, rather than by one point person (p = 0.02), saw more new consults annually.

Conclusion: There has been a growth of geriatric oncology services in Canada and the U.S. within the last five years. The composition and structure of clinics varies widely though the majority have both geriatrics and oncology expertise. Support to build more geriatric oncology services is needed to reach more older adults with cancer. This study provides some insight into ways to structure these clinics.

Keywords: Clinical care; Geriatric oncology; Models of care.