Outcomes of the New Geriatric-Oncology Service at University College London Hospital​

Introduction: Older adults with cancer and frailty face increased hospitalisation and mortality. University College London Hospitals (UCLH) established a new Geriatric-Oncology clinic for specialist assessment and management of these patients. This evaluation examined rates of emergency department (ED) attendance, unplanned hospital admission and one-year mortality, and whether frailty was associated with these outcomes, in patients seen in this clinic.

Methods: Electronic records were reviewed for attendees between January-2024 and April-2025. Spearman’s rank correlation assessed associations. Multivariable logistic regression evaluated independent associations, reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). p<0.05 was significant.

Results: Of 217 scheduled appointments, 169 patients attended. Median age was 81-years (interquartile range[IQR]:75–86); 96(56.8%) were female. Median Clinical Frailty Score(CFS) was 4(IQR:4–5) and Performance Status(PS) was 2(IQR:1–2). 

Within one year, 84(49.7%) patients attended UCLH ED; median time to first ED attendance was 126 days (IQR:55.5–226.5). 67/169 patients received anti-cancer therapy; of these 31 attended the ED within 12-months; 30 received systemic anti-cancer therapy and 4 received radiotherapy. Adjusting for age, gender, cancer site, and disease stage, being on anti-cancer treatment was not associated with ED attendance(OR:0.70,95%CI:0.30–1.59;p=0.390). 59(34.9%) experienced an unplanned admission; median length of stay was 6-days(IQR:3–13). Among admitted patients, respiratory conditions (25/59,42.4%), and frailty syndromes (12/59,20.3%) were commonest. CFS was weakly associated with ED attendance(rₛ=0.145,p=0.041) and admission(rₛ=0.210,p=0.003).

64(37.9%) patients died within one year. Mortality correlated with CFS(rₛ=0.145,p=0.022), ED attendance(rₛ=0.151,p=0.033), admission(rₛ=0.214,p<0.001) and PS(rₛ=0.222,p<0.001). Neither CFS(OR:1.27,95%CI:0.95–1.71;p=0.102) nor PS(OR:1.43,95%CI:0.96–2.13;p=0.076) predicted mortality in the multivariable model.

Conclusions: Patients attending the Geriatric-Oncology clinic experienced high rates of ED attendance, hospitalisation and one-year mortality. Greater frailty was associated with emergency healthcare use and mortality. Future work should compare outcomes with patients not attending the service and evaluate treatment adherence, toxicity and its role[CF1]  in ED attendance and hospitalisation, and cancer remission.