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S108
A B S T R A C T S
P121
PREHABILITATION AND REHABILITATION IN
ONCOGERIATRICS: ADAPTATION TO DISEASE AND
ACCOMPANIMENT OF PATIENTS’ TRAJECTORIES
O. Le Saux
1,
*, C. Falandry
1
1
Geriatric oncology, Centre Hospitalier Lyon Sud, Pierre-Bénite,
France
Introduction:
Many oncological situations induce complex
medical and surgical procedures, which may reveal or
decompensate a geriatric underlying vulnerability.The current
developments of outpatient treatment or postoperative rapid
rehabilitation strategies do not take into account this geriatric
vulnerability. A new healthcare organization is therefore
needed in order to develop geriatric rehabilitation.
Objectives:
Our pilot project named PROADAPT (Prehabili-
tation and Rehabilitation in Oncogeriatrics: Adaptation
to Disease and Accompaniment of Patients’ Trajectories)
aims at developing and evaluating a rehabilitation program
integrating interventions to prevent geriatric deconditioning.
This program includes four interventions: (1) a nutritional
management (2) a physical rehabilitation pre- (prehabilitation)
and post-treatment (rehabilitation) (3) the prevention of
iatrogeny and (4) a hospital-home transition.
Methods:
To develop this program, the first step was to
evaluate available scientific data. Four working groups (one
per intervention) consisting of several health professionnals
(nurses, nutritionists, pharmacists, geriatricians, oncologists
and surgeons) were formed. We will present the work of
the third group. The search strategy was performed using
Pubmed on April 2016 using Mesh terms (“Medication
Reconciliation”[Mesh] OR “Drug-Related Side Effects
and Adverse Reactions/prevention and control”[Mesh]
OR “Medication Errors/prevention and control”[Mesh])
AND (“Aged”[Mesh] OR “Aged, 80 and over”[Mesh] OR
“Neoplasms”[Mesh]) and limits: “Humans” AND “English”.
Results:
A total of 1490 articles were found and analyzed
by five physicians (three geriatricians, one oncologist and
one pharmacist). To prevent iatrogeny, elements retrieved in
literature with varying levels of evidence were: comprehensive
geriatric assessment to assess risk factors, pharmacists’
interventions [1], medication reconciliation, medication
review [2], therapeutic education programs, outpatient care
transitions programs, computerized physician order entry,
electronic medication administration record. Medication
review included a multistep process: avoid and be vigilant
of high risk drugs, discontinue potentially inappropriate
drugs, consider drugs as a cause of any new symptom and
avoid trating side effects with another drug, avoid drug-
drug or drug-disease interaction, adjust dosing based on
age, creatinine clearance and hepatic function, address
non-adherence, search for duplications or deficiencies in
medications, try to simplify the medication schedule and
search for non pharmacologic alternatives.
Conclusion:
Using available scientific data, the four groups
are currently developing clinical practice guidelines. These
guidelines will enable the construction and implementation
at a regional level of a healthcare system program in geriatric
oncology in order to prevent geriatric decontioning for elderly
cancer patients at high risk of frailty undergoing complex
medical or surgical procedures.
References:
[1] Gillespie U,AlassaadA, Henrohn D, Garmo H, Hammarlund-
Udenaes M, Toss H, et al. A comprehensive pharmacist
intervention to reduce morbidity in patients 80 years
or older: a randomized controlled trial. Arch Intern Med.
2009;169(9):894-900. doi:10.1001/archinternmed.2009.71.
[2] Christensen M, Lundh A. Medication review in hospitalized
patients to reduce morbidity and mortality. Cochrane
Database Syst Rev. 2016;2:CD008986. doi:10.1002/14651858.
CD008986.pub3.
Disclosure of interest:
None declared
Keywords:
Frailty, iatrogeny, nutrition, rehabilitation, surgery
P122
EDUCATING 400 NURSES IN GERIATRIC ONCOLOGY ACROSS
THE US (FUNDED BY THE NATIONAL INSTITUTE OF HEALTH
#R25CA183723-01A1)
P. S. Burhenn
1,
*, C. Okamoto
2
, D. Economou
3
, R. Yang
1
, C. Sun
4
,
A. Hurria
5
1
Geriatric Oncology,
2
Professional Practice and Education,
3
Nursing
Research and Education,
4
Outcomes Research,
5
Cancer and Aging
Research Program, City of Hope National Medical Center, Duarte,
USA
Introduction:
Oncology nurses play a key role in the
healthcare team that interfaces with older patients with
cancer; however, they receive very little education in
evidence-based geriatric practice thus creating a critical
gap in the overall knowledge of how to care for older adults
with cancer. The Institute of Medicine report “Retooling for
an Aging America” identified a critical need to increase the
geriatric education of nurses. We responded by applying for
an NIH R25 grant “Geriatric Oncology: Educating Nurses to
Improve Quality Care” which was awarded to educate 400
oncology nurses in geriatrics.
Objectives:
The objectives of the R25 grant are: 1) To develop
and implement a national curriculum in geriatric oncology
for oncology nurses; and 2) To evaluate the effectiveness of
this curriculum by pre and post knowledge testing, course
evaluations, and evaluation of knowledge integration.
Methods:
The overall 5-year strategy of the program is to
conduct 3-day geriatric oncology courses once per year for
four years (total number trained – 400 nurses).The curriculum
which includes both didactic and interactive sessionswas built
around the principles of geriatric assessment. Expert faculty
in geriatric oncology will develop and deliver the content. The
key domains that are covered include: physiological changes
in aging, comorbidity, functional changes, cognition and
mental status, nutrition, social support, polypharmacy, and
geriatric syndromes.The program also addresses empowering
nurses, working with leadership to implement change,
the interdisciplinary team, caregiver support, and utilizing
community resources. The participants will be competitively
chosen in 3-person teams from each institution based on