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To mark the International Day of Older Persons, held on Oct. 1, the Department of Supportive Care at Princess Margaret Cancer Centre spoke to Dr. Shabbir Alibhai. Dr. Alibhai is Medical Lead for the Older Persons with Cancer Clinic and he tells us about the clinic's approach to providing the best care for older adults with cancer.
How are the needs of older adults with cancer different from younger people with cancer?
As people get older, there is more often complexity with aging, meaning that many older adults have multiple other medical conditions. They are on multiple medications. They can have functional limitations and/or cognitive difficulties. Altogether these things make them more complex and vulnerable and may increase the risk of cancer treatment or make it more difficult to tolerate any cancer treatment.
Tell us about the Older Adults with Cancer Clinic at Princess Margaret.
The Older Adults with Cancer Clinic was established in June 2015 at the Princess Margaret to see complex, frail or vulnerable older adults who are going through the cancer journey.
How does the clinic promote Personalized Cancer Medicine?
Personalized Cancer Medicine really refers to making sure that we get the right treatment to the right patient at the right time. There is a lot of research at the Princess Margaret and a lot of the clinical care focuses on the cancer, the genetics and other factors.
Our clinic focuses on the older person with the cancer (the "host"), and we want to get them in the best position to get the right cancer therapy. We assess their medications, their medical conditions, their function, and their cognition in order to avoid overtreatment or under treatment of a given patient.
What supportive care services does the clinic provide?
We want to enhance their supportive care plan to get patients through their cancer journey as smoothly as possible, which may mean activating extra resources in the community, such as increased home care support and access to dietitians or social workers. Our nurses also provide a lot of education to patients and their families about managing their cancer symptoms and treatment side effects.
Can you describe a typical patient that your team sees in the Older Adults with Cancer Clinic?
The typical patient in our clinic tends to be fairly old, in their late 70s or 80s. They're going through cancer treatment often with radiation or chemotherapy. What we have seen is some of these more complex patients who have further complications from their treatment, such as weight loss, pain or low blood pressure. We have helped to optimize the other medical conditions to reduce unnecessary medications and give them better pain and symptom management.
Looking ahead, what does your team plan to achieve in the second year of the clinic?
We have three main goals for this coming year.
First, we recognize there are many older adults with cancer who come to the Princess Margaret. In fact, 40 per cent of the patients coming to the Princess Margaret are aged 65 and over. Our clinic can't possibly see all of them, nor do we need to see all of them. Thus one of our main goals is to raise awareness and promote education to point-of-care staff, so that everyone is more aware of the special needs of older adults.
Our second major goal is to emphasize seeing patients in the pre-treatment decision phase, who may be complex. We hope to minimize over-treatment and under-treatment, so that they can go through their cancer treatment as best as possible
Our third goal is to expand the clinic this year to focus on patients with gastrointestinal cancer, because in our first year we focused on patients with genitourinary cancer.
What is your message to healthcare providers seeing older adults with cancer at UHN?
I have two main messages for healthcare providers at UHN. First of all, there are a lot of older adults with cancer. Although they don't all have complexity, frailty and vulnerability, it's not always obvious to spot them from 10 feet away. I think we need to be more aware and do a systematic assessment of the needs of older adults with cancer, while thinking of areas like function, cognition, and nutrition in order to make sure that we really understand the whole person.
My second message is that for those who are seen as vulnerable, complex, or frail, our clinic exists. We are happy to see these patients and help healthcare professionals manage these older adults and make sure that the treatment we give them is the best one and the safest one for them.
The Older Adults with Cancer Clinic is one of the strategic initiatives under the Princess Margaret Personalized Cancer Medicine
Strategic Plan. To learn more about the Older Adults with Cancer Clinic,
read this recent article published by the team or email the team at OACC@uhn.ca.