Challenges in the Practice of Geriatric Oncology in a National Comprehensive Cancer Centre in Asia
Challenges in the Practice of Geriatric Oncology in a National Comprehensive Cancer Centre in Asia
ASIA PACIFIC ONCOLOGY & HAEMATOLOGY - VOLUME 1
Published: April 2009
Published: April 2009
As an industrialised nation, Singapore shares similar societal and healthcare concerns with other developed countries. It has a multiracial society comprising different ethnicities: 75% Chinese, 14% Malays, 9% Indians and 2% Eurasians and other groups. The twin emergence of an ageing population and cancer as the leading cause of mortality has led to the burgeoning increase in the population of elderly patients with cancer. In Singapore, the number of elderly people older than 65 years of age as a percentage of the general population is projected to increase from 6.8% in 1995 to 20% by 2030, and cancer disproportionately affects more of those who are 65 years of age or older. At the National Cancer Centre Singapore (NCCS), patients aged 70 years or older account for about 40% of the 130,000 clinic attendances per year. In December 2006, a geriatric oncology programme was launched by the NCCS as a seminal framework to support research and clinical service development and to address the multifaceted challenge of managing the elderly with cancer.
The National Cancer Centre Singapore Geriatric Oncology Programme
The programme comprises outpatient and inpatient components, with a clinical research agenda interweaved into the service. The outpatient clinic in the NCCS is staffed by a medical oncologist and a nurse co-ordinator. There are plans to hold a joint geriatrician–oncologist clinic for management of complex cases at NCCS. All NCCS oncology patients are admitted to Singapore General Hospital (SGH) at the Outram Campus, which hosts a number of national healthcare centres under the management of the parent organisation SingHealth. On average, there are 80 oncology patients in the ward at any one time. A weekly multidisciplinary round for selected elderly cancer patients with challenging problems is held in the oncology ward with geriatricians, palliative care physicians, nurses and related health professionals, i.e. nutritionists, physiotherapists, occupational therapists and social workers. These collaborators are from SGH. Monthly research meetings and talks are held to co-ordinate all research activities within geriatric oncology, discuss new research ideas and also to provide a platform for the various specialties to share new insights. The NCCS largely funds the geriatric oncology programme, with a significant proportion from private philanthropy supporting clinical research.
The Comprehensive Geriatric Assessment
The outpatient geriatric oncology clinic is where patients who are older than 70 years of age with all diagnoses of cancer are referred and managed. Prior to the consultation with the medical oncologist, the nurse programme co-ordinator will perform the Comprehensive Geriatric Assessment (CGA). The CGA entails collecting information on an individual’s personal and social profile, including family support, physical performance using hand-grip strength, ‘get up and go’, functional status recorded using the Eastern Co-operative Oncology Group (ECOG) scale, instrumental activities of daily living (IADL) and the Katz index of activities of daily living, co-morbidity using the Charlson risk index, affective domain using the geriatric depression scale, cognitive domain using the clock drawing test, the abbreviated mental test, the mini-mental state examination (MMSE), the care-giver burden interview, the mini-nutritional assessment test and polypharmacy.
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