The presentation today was about the role of the geriatrician or the primary care physician in the care of older adults with cancer. It comes from what we actually do at Memorial Sloan Kettering where we take care of older adults with cancer and we are in charge in many times of their comorbidities or their polypharmacy or the geriatric syndromes that they are affected with. There is not much literature about what is the optimum care so we are just making our way as we go but there is an increasing need of involvement of geriatricians and primary care physicians in the care because of the number of patients that actually need to be followed.
So there are many other groups who help with patient care?
Right, it should be a team effort more than an individual effort. Patients with cancer that are older come with all the baggage of geriatric syndromes and comorbidities as well as the cancer. So sometimes it becomes really a huge undertaking for the oncologist to take care of the whole patient and it would be in the best patient interest to have a team effort.
What about survival vs quality of life?
The survival, the quality of life, the quality of life of the patient, the quality of life of the caregiver, what are the patient’s goals for their care all comes into play. It’s quite complicated and many times very time-consuming so it’s much better addressed in a team effort.
Can the work you do at the Kettering Centre be translated elsewhere?
We are always told that we are such a big institution and there are so many resources that many times our experience cannot be translated into other scenarios. But even if it’s not the whole of what we do but parts and pieces of what we do can be translated. Even if it’s just awareness on the side of the oncologist and on the side of the primary care physician that this is a need that would be a start.
Will SIOG guidelines follow soon?
At this point we are not yet at that point of having guidelines for this particular subject because of the low amount of evidence based data that we have. But it’s a very open field and a field in need of future research. The young investigators that are coming over SIOG should have a look into it.
How can people interested get involved?
If anybody is interested in pursuing this line of research they can contact me, we can have a conversation, we can start having at least an idea of what are the questions to be asked and maybe try to adapt some of the possibilities that we have into their own institutions. Everybody has different amounts of researchers that they can allocate, depending on if this is a cancer centre, it’s a general hospital, it’s a community hospital, it depends on where you work what kind of this type of work you can do.
Can this be implemented in places with lesser resources?
It definitely can. Communication between the physicians that are taking care of the individual patient can be done even with no resources. You can just pick up a phone or just send your note or try to make sure that you meet with somebody once in a while. These kinds of things are low budget or can be high budget, it depends on how much resources you want to allocate. But having shared care of a patient can be done with any kind of budget.
So the only barrier is time and human resources?
Right, it’s time, it’s awareness, it’s willingness, it’s understanding the importance of it. It’s just getting used to the idea or having a mechanism to do it. From the part of the primary care physician there is a large need of education because many of them do not know enough about how to take care of patients that are survivors of cancer. So they are a little bit resistant or they have no idea of who is responsible for what or they don’t have any financial incentives because these patients are very complicated and they take a lot of time. So there are many barriers that we need to overcome to get to a good model.
If you could summarise?
In summary this is an important subject, mostly because of the number of patients that live much longer with cancer as a chronic condition and because the number of these patients that need to be followed will increase dramatically it definitely will need to have a common work between the oncologists with the primary care physician of the patient.
