Earlier this year I’ve joined the SIOG taskforce on quality of life in older cancer patients. It’s a bridge international group and what we have been working on since the beginning of the year is a paper, a position paper, where we want to look at quality of life assessment in those patients, that’s a group of patients promote… it’s mainly to raise awareness actually. We want hopefully to promote that assessment and even implement in some units that aren’t currently doing it.
What are the key factors that you’re looking at in that assessment?
When we look at older patients we’ve been seeing that the majority of them are actually older cancer patients. We’re not expecting the age itself to impact or to decrease the quality of life. It may impact because at least the age associated changes will change the perception of quality of life in older patients when you compare with younger. So a lot of times as physicians we tend to assume that we know what is the best for the patient, what is in their best interest, sometimes we don’t. Sometimes we have difficult cases where we think, ‘I don’t really know what is best for the patient.’ So getting that assessment could help us find the best pathway for that patient.
To do the quality of life assessment the main thing is they will need to explore what are the fears of the patient, their expectations, their needs, their preferences. By doing that we can identify some unmet needs, we can personalise the treatment and hopefully after all of this we can actually get better cancer care.
So more discussion between doctor and patient?
It is my experience but I think that something that we experience in a lot of hospitals. We don’t have a lot of time; our focus throughout training is always, ‘Let’s assess the patient. What is the best treatment for them?’ We have improved quite a lot assessing how fit is the patient for a specific treatment but then assessing what does the patient really want or other unmet needs in the middle of this process sometimes they are plan B in the middle of all of this. So we should definitely improve in that communication in assessing those needs because every patient will be different and the main thing is we need to align our goals as physicians with the goals of the patient.
Who has a key role to aid increasing patient dialogue?
Everyone should be involved, it wouldn’t be just the physicians definitely agree, it would involve nurses, patient advocates. It is a team effort and definitely we should improve on that.
How can we get everyone to adopt this discussive mindset?
I bring that idea into the head of some colleagues and a lot of the time the fear is time because while we’re doing all of this we don’t have that much time. So if we go into those detailed discussions maybe we will lose some time. I think it’s probably the other way around because if you have those discussions right at the beginning, and even throughout the process, that will save you time because you cannot just understand better your patients and their needs but adjust the treatment and the plan for that specific patient. So that will actually probably save you time and even resources later on.
