Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings.
Vol 23, No 16S (June 1 Supplement), 2005: 8279
© 2005 American Society of Clinical Oncology

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Abstract

A combined consultation service in geriatrics and palliative care for geriatric oncology patients

Univ of Texas Health Science Ctr at San Antonio, San Antonio, TX

8279

Background: As many as 60% of cancer patients are 65 or older. However, geriatric patients may receive care from physicians lacking formal training in geriatrics. Geriatric oncology is a growing field and seeks to provide expert care to the elderly with cancer, improving outcome measures such as quality of life. Palliative care programs address quality of life issues, but few are specifically related to elderly populations with complementary geriatric expertise. Our combined consultation service provides expertise and interdisciplinary teaching in both: Geriatrics and Palliative Care. Clinical Case: A 67-year-old man with history of lung adenocarcinoma(stage IV: Brain and adrenal metastasis) was admitted to orthopedics with left hip pain after a fall. Further evaluation revealed no fractures but was found to have Hb=3. He was also thrombocytopenic. Our service was consulted for further geriatric medical management. On examination, vital signs were noted for regular tachycardia. He had severe left groin tenderness. He was transfused with good response. Prednisone was started for idiopathic thrombocytopenic purpura. Bone scan showed possible left iliac bone metastasis. Family conference was held and it was decided to pursue further chemotherapy and radiotherapy. Despite treatment, his platelets worsened. Our combined service was also able to address his uncontrolled pain. Morphine dose was adjusted which relieved his pain significantly. Patient was no longer symptomatic. After multiple conversations with family and primary team and given his poor prognosis, comfort care approach was decided upon. Conclusions: Our service provided this patient with appropriate special care at a given time. The literature lacks evidence on the effect of combined programs in geriatrics and palliative care, with physicians that have dual expertise. This setting is ideal to contribute to the management of patients with severe chronic illnesses such as cancer. Geriatric oncology trainees are part of our service. We believe it is essential for oncologists to acquire expertise in the field of geriatrics and palliative care. Future research is needed to evaluate the impact of this type of programs on patient care and quality of life.

No significant financial relationships to disclose.