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A B S T R A C T S
S117
in cancer services across the UK, nor the prevalence of existing
dedicated geriatrics services for cancer patients, nor whether
urgent access to relevant professionals is available.
Objectives:
To identify current assessment methods used
for older people in UK cancer services and to identify current
access to relevant services.
Methods:
Online survey (Survey Monkey) of oncologists,
geriatricians, oncology nurses, surgeons, allied health
care professionals and others distributed via a number
of UK professional societies including the Association of
Cancer Physicians, Royal College of Radiologists, British
Geriatrics Society, UK Oncology Nursing Society and others.
Respondents were asked a number of questions regarding
current assessment methods for older people and access to
geriatricians and other relevant services.
Results:
640 health care professionals responded to the
survey between January to April 2016. Current assessment
methods were largely history taking (98%) and using
performance status (90%). Published scoring tools were not
frequently used (34%). Most respondents reported they would
notconsiderusingmanyofthecommonvalidatedtoolstoapply
to clinical practice including the G8, frailty and comorbidity
scores. Only 14% often/always had geriatricians involved in
the assessment of an older people in cancer services. Few had
urgent access available to key professionals including only
25% having urgent access to geriatrician, 25% urgent access
to social workers, 27% urgent access to psychological support,
16% urgent access old age psychiatry input and 17% urgent
access to specialist nurses in older people. Although 15%
reported to have some dedicated geriatrics services for cancer
patients, many of these services were reported to be funded
by temporary charity funding questioning whether some
of these services will be sustained. 70% of respondents had
interest in further developing services linking older patients
in cancer services to geriatricians.
Conclusion:
Traditional methods of clinical assessment
were favoured to completing tools. This may suggest that any
tool applied to the UK should be brief and focus around clinical
history to have clinician buy-in to use it. Urgent geriatrician
access is sparse therefore models of care to deliver improved
assessments and CGA interventions must involve up-skilling
cancer services.
Reference:
[1] Independent Cancer Taskforce (2015) Achieving World-
Class Cancer Outcomes A Strategy For England 2015-
2020 Report. Available at:
https://www.cancerresearchuk.
org/sites/default/files/achieving_world-class_cancer_
outcomes_-_a_strategy_for_england_2015-2020.pdf
(last
accessed 14th June 2016)
Disclosure of interest:
None declared
Keywords:
Access to services, geriatric assessment, survey
P136
ONCOLOGICAL SURGERY IN AGED 80 OR MORE:
PREDICTORS OF FUNCTIONAL DECLINE AND MORTALITY IN
ONE YEAR
L. A. Gil-Jr
1
, T. Karnakis
1,
*, A. L. Kanaji
1
, B. A. Martins
1
,
J. C. Oliveira
2
, M. D. C. Sitta
3
, W. Jacob-Filho
3
1
Geriatrics,
2
Internal Medicine, Cancer Institute of Sao Paulo,
3
Geriatrics, University of Sao Paulo, Sao Paulo, Brazil
Introduction:
Surgical treatment is the main treatment
for solid tumors. However, there is enough evidence that the
geriatric population does not receive the potentially curative
treatment when compared to younger population. It is still
necessary to assess the impact of Global Geriatric Assessment
on the ability to predict perioperative complications,morbidity
and mortality in a cancer population over 80 years.
Objectives:
To analyze predictors of functional decline and
mortality in 12 months in octogenarians with solid tumors
undergoing cancer surgery, at Cancer Institute of São Paulo, in
the year 2013 through the components of the Global Geriatric
Assessment (CGA).
Methods:
Prospective cohort study of patients undergoing
non-emergency cancer surgery and evaluated the preoperative
period for Perioperative service in the São Paulo State Cancer
Institute.
Results:
492 patients were evaluated in the Surgical Risk
Geriatrics Clinic from January 2013 to May 2014. Of these
81 patients did not undergo any surgery within 3 months
following the evaluation and 153 operated outside the period
of interest of the study (June-13 to May-14). Remaining 258
patients were properly screened for eligibility criteria. 60
patient were excluded (15 local anesthesia, 16 incomplete
records and 29 for other reason). Of the 198 patients evaluated,
only one refused to participate in the research being deleted
before collecting other information.
Mean age was 83.8 (±3.5)and 57,9% were male. Most
common cancers were urinary tract with 23.9%, followed by
gastrointestinal (16.2%), skin (14.7%) and breast (14.2%). 10.7%
were metastatic cancer.
Survival analysis using as outcome the time to death in
days demonstrate that variables that were independently
correlated to the time to death were IADL with HR = 0.82
(95% CI = 0.74, 0.92) p = 0.001 and MMSE with HR=12:24 (95%
CI=0:06;0.92), p = 0:04.
Table 1 (abstract P136)
Logistic Regression
Functional Decline
MMSE
OR=0,14
IC 0,025–0,86
p=0,034
Lawton (IADL)
OR=0,73
IC 0,63-0,86
p< 0,001
Charlson
OR = 2,04
IC 1,01-4,2
p=0,044
Male
OR = 0,073
IC 0,01-0,5
p=0,043
Mortality
MMSE
OR 0,049
IC 0,005-0,48
p=0,01
Lawton
OR 0,68
IC 0,54-0,87
p=0,002
Conclusion:
Consistently with previous findings for
perioperative complications and mortality we found strong
correlation of functional loss and mortality in a year, with