Development and implementation of an interdisciplinary telemedicine clinic for older patients with cancer—Preliminary data

• Published in: Journal of the American Geriatrics Society (JAGS) 2023-05, Vol.71 (5), p.1638-1649
• Main Authors: Alexander, Koshy, Hamlin, Paul A., Tew, William P., Trevino, Kelly, Tin, Amy L., Shahrokni, Armin, Meditz, Elissa, Boparai, Manpreet, Amirnia, Farnia, Sun, Sung Wu, Korc‐Grodzicki, Beatriz
• Format: Article
• Language: English
• Subjects: Aged; Aging; asynchronous assessment; Cancer; Cancer therapies; Chemotherapy; COVID-19; Decision making; Elder care; Geriatric Assessment; geriatric oncology; Humans; hybrid model; Interdisciplinary aspects; Life span; Morbidity; Neoplasms - therapy; Older people; Pandemics; Patient satisfaction; Patients; Preliminary Data; Telemedicine
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18267

Background Frailty assessment is an important marker of the older adult's fitness for cancer treatment independent of age. Pretreatment geriatric assessment (GA) is associated with improved mortality and morbidity outcomes but must occur in a time sensitive manner to be useful for cancer treatment decision making. Unfortunately, time, resources and other constraints make GA difficult to perform in busy oncology clinics. We developed the Cancer and Aging Interdisciplinary Team (CAIT) clinic model to provide timely GA and treatment recommendations independent of patient's physical location. Methods The interdisciplinary CAIT clinic model was developed utilizing the surge in telemedicine during the COVID‐19 pandemic. The core team consists of the patient's oncologist, geriatrician, registered nurse, pharmacist, and registered dietitian. The clinic's format is flexible, and the various assessments can be asynchronous. Patients choose the service method—in person, remotely, or hybrid. Based on GA outcomes, the geriatrician provides recommendations and arrange interventions. An assessment summary including life expectancy estimates and chemotoxicity risk calculator scores is conveyed to and discussed with the treating oncologist. Physician and patient satisfaction were assessed. Results Between May 2021 and June 2022, 50 patients from multiple physical locations were evaluated in the CAIT clinic. Sixty‐eight percent was 80 years of age or older (range 67–99). All the evaluations were hybrid. The median days between receiving a referral and having the appointment was 8. GA detected multiple unidentified impairments. About half of the patients (52%) went on to receive chemotherapy (24% standard dose, 28% with dose modifications). The rest received radiation (20%), immune (12%) or hormonal (4%) therapies, 2% underwent surgery, 2% chose alternative medicine, 8% were placed under observation, and 6% enrolled in hospice care. Feedback was extremely positive. Conclusions The successful development of the CAIT clinic model provides strong support for the potential dissemination across services and institutions.