SIOG 2014

"Cancer buddies" provide empowerment for the elderly

Prof Margot Gosney - Reading University, Reading, UK

We have buddies who are volunteers from all sectors who are available to support older people with cancer. They can do anything, as long as it’s legal; they don’t provide personal care but they may help somebody with their shopping immediately after their surgery or they may just be supporting somebody by coming in daily for somebody’s radiotherapy, just so that they have some company.

Why is this service only for patients over 70?

We know that a lot of the over -70s don’t accept treatment and they do that for a variety of reasons. For many of them it’s because they have a caring responsibility. 20% of the over-65s, whether they have cancer or not, provide at least 20 hours of voluntary support every week for perhaps a spouse or another relative and these are people who may say no to chemotherapy or no to radiotherapy because they’re afraid to leave, perhaps, a spouse in the house who has dementia or challenging behaviour.

What are you able to do for patients?

We can make sure that a spouse with dementia can be supported for two or three hours a day while that patient comes along for their chemotherapy, not worrying about what’s happening at home. We can make sure that if somebody has no transport that they are taken into the hospital with somebody, they’re taken to the department they need to go to and they can have all the support. These are patients who perhaps traditionally wouldn’t have accepted chemotherapy or radiotherapy because they felt it was too aggressive or they may have started their treatment and then stopped it for a variety of reasons.

What is the importance of seeing patients with any form of cancer?

I think it’s very difficult. We don’t know what we don’t know and sometimes we think that the patients who are going to need most support are those with colorectal cancer or having major surgery but actually something more… a smaller cancer, a smaller tumour that may not actually kill the patient, they may need even more support than those people that are undergoing extensive and aggressive therapy. We see everybody for an interdisciplinary assessment and we try to do it before the patient actually comes to hospital.

Where do you find the resources to provide this?

We save a lot of money by our service in the increasing economic environment that we’re all working in. If we see patients before they come into hospital we can pre-plan their discharge; we can make sure that their discharge from hospital is smooth, with all of the services and all of the support that they need and that’s what saves money in a very cash-strapped economy to reduce length of stay.

Why are clinicians with both geriatric and oncology experience so important?

We are in a situation where we need to trust each other. I need to be able to go on a surgical ward round and say to the surgeon, “I really don’t think that’s the best for this patient.” And likewise the surgeons need to be able to say to me, “Margot, I need you to fix this particular aspect of the patient.” The fact that I have got some oncology background, albeit a long time ago, means that I have street credibility. Geriatricians in the United Kingdom have played a very small role in cancer management, that’s going to increase as time goes on.

What are the things that can go wrong?

Certainly with very old patients, spouses may feel that it’s not the right thing. But particularly younger siblings will say, “I’m not sure that Mum’s up to this.” I think it’s very important that with an interdisciplinary approach we can say, “We might not be able to change Mum’s age but we certainly can assess her, we can interact, we can optimise her therapy and we can make her risk of undergoing chemotherapy or any other surgery lessened.” So we are really acting as the patient’s advocate and it’s difficult to act as an advocate against a family member but sometimes that’s what an older person needs.

What’s the take-home message for clinicians?

Get friendly with your geriatrician, we have a lot to offer. We can provide not only medical support but we can lead an interdisciplinary team that will help your patients. Remember that a lot of the psychosocial support that older people need could be provided very inexpensively with a buddy service or a similar service.