JMIR Publications

ABSTRACT

Background:

Malignancies are the leading cause of disease burden in Australia, comprising 19% of total diseases. An estimated one in four men and one in six women die from malignancies by the age of 85, with patients >65 years contributing to 58% of diagnosed cases and 76% of cancer mortality. In this context characterised by malignancy-related disease and age-related degeneration, there is a need for comprehensive assessment of older (geriatric) patients (CGA) in order to plan for appropriate management and to predict prognosis. The utility of available CGA tools has been limited in routine practice due to their time consuming nature, despite such assessments enabling clearer understanding of older patients’ functional status, informing better clinical decision making, facilitating prevention of unpredictable admissions and overload in the emergency department, and informing planning of support services and bed occupancy. Though there are several promising tools available, there is a lack of literature on clinical tools which can comprehensively assess functional status, particularly in an expedited fashion.

Objective:

This study aimed to document functional status and co-morbidities among a geriatric oncology patient cohort attending a regionally-located, dedicated cancer care facility, using existing ‘Adelaide tool’ geriatric patient assessments. This study documents specific aspects of this cohort, including sociodemographic characteristics, malignancy type, and comorbidities. It also examines the utility of an abridged functional assessment in the management of older cancer patients.

Methods:

The study comprised a facility-based cross sectional audit of results obtained from a screening tool (‘Adelaide tool’) administered to patients aged >65 years and attending an outpatient medical oncology clinic for management of cancer during 2016/17. Data relating to five domains was collected, including: Instrumental Activities of Daily Living; Activities of Daily Living; performance status; unintended weight loss; and exhaustion. Sociodemographic and disease related factors were summarized as frequencies with percentages or mean with standard deviation. Distribution of functional status based on socio demographic characteristics, living status, disease related factors and comorbidity status was analysed using a chi square test. Cumulative dependencies in the five domains were identified, and patients classified as Fit, Vulnerable, or Frail.

Results:

A majority of the study population (n=274) showed poor functional status, with 88.7% categorised as vulnerable, and 8.4% as frail. Exhaustion and unintended weight loss were identified as the most common contributors to dependency.

Conclusions:

The outcomes of this study, especially identification of a significant proportion of older patients classified as vulnerable or frail, are congruent with the existence of dependency in various domains. The Adelaide tool provided a useful basis for multi-disciplinary discussion and management. Further examination of the tool’s impact on clinical decision making, and the distribution of dependencies in a rural cohort as compared to metropolitan patients, is needed.