3064 - Development of GOLD (Geriatric Oncology Liaison Development) service to improve outcomes in older people with cancer

Background

The number of older people with cancer has been steadily increasing. Treating older people with anticancer treatments is challenging due to comorbidities, polypharmacy, poorer performance status and underrepresentation in clinical trials. An innovative service, GOLD, has been set up in our Cancer Centre. GOLD delivers comprehensive geriatric assessment (CGA) in older cancer patients to improve reversible factors and assist with anticancer treatment. We report outcomes of patients reviewed in GOLD clinic.

Methods

A one-stop GOLD clinic for older cancer patients was set up in 2016. From October 2016 to April 2018, 596 patients between 50-99 years old were reviewed. The majority (69.9%) were between 70-84 years. For the purpose of this analysis, a representative sample of 298 patients with similar characteristics (73% between 70-84 years) was selected; analysis included primary site of malignancy, treatment type and setting, referral reason and GOLD interventions. Cancer treatment outcomes were divided into patients who continued with planned treatment, and those who required other types of management.

Results

Referrals to GOLD were predominantly from gastrointestinal (28.5%), urology oncology (26.1%) and haematology (13.7%); lung, gynaecology, skin and breast accounted for the remaining 31.7%. The majority (92.7%) had single GOLD reviews. The following treatments were given: systemic anti-cancer therapy (SACT) with chemotherapy (51.6%), hormone therapy (21.1%), immune checkpoint inhibitors (6.8%), chemo-radiotherapy (6.8%) or tyrosine kinase inhibitors (3.6%). Of the 298 patients, 218 (73.2%) were able to proceed with their planned oncology treatment following GOLD review, start or continue SACT. 12.4% were deemed unfit and continued with best supportive care, 0.3% were referred to other specialities. 14.1% of the patients were on surveillance post anticancer treatment.

Conclusions

Collaborative working of oncologists with geriatricians may benefit older cancer patients with co-morbidities and age-specific problems. GOLD was largely “one-stop” and avoided multiple speciality referrals which may support cost-effectiveness whilst delivering more comprehensive care for older people with cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

MacMillan Cancer Support.

Disclosure

All authors have declared no conflicts of interest.