18 months of OACOS: Evaluating the OACOS (Older Adults Cancer Optimisation Service) at a District General Hospital in Somerset

Introduction

Increasing numbers of patients live with both frailty and cancer, highlights highlighting the need for onco-geriatric services. Comprehensive Geriatric Assessment (CGA) of older oncology patients increases QoL and treatment tolerance. Recent guidance from British Geriatrics Society stresses the importance of frailty assessment to identify and optimise frailty related issues, alongside collaborative decision-making with patients.

Methods

OACOS was created at a District General Hospital in Somerset to identify and medically optimise frail patients in whom the treating oncologist had concerns about their ability to tolerate radical cancer treatment. Patients were referred to the service for a therapy assessment and geriatrician-led CGA to further investigate and manage concerns relating to co-morbidity, social isolation, cognitive impairment and falls.

Results

Between September 2022 and March 2024, 68 patients were discussed in Oncogeriatrics MDT. 49 patients were seen in the accompanying Oncogeriatric clinic. Reasons for not being reviewed included not meeting referral criteria, redirection to alternative specialist clinic, sole OT input required and patients declining.

Patients seen in clinic had an average CFS of 4 and an average G8 score of 12.5

All patients seen in clinic saw a geriatric consultant or registrar, with 84% of patients seeing a physiotherapist for a personalised assessment. 92% of patients had a treatment escalation plan completed. All patients had a medication review with 93% of those seen having at least one medication discontinued. Other key interventions included optimisation of blood pressure, cognition and anaemia.

Conclusions

Patient feedback has been positive, appreciating the opportunity to review their health, optimise medical issues and reduce medication burden. Oncologists have appreciated rapid access to holistic geriatrician review alongside therapy input to improve health outcomes. Further exploration into patient’s reasons for declining review by OACOS may help identify barriers to access for some patients and the future clinic model.