Implementation of a Dedicated Oncogeriatric Clinic for Colorectal and Hepatobiliary patients in a large UK NHS trust

Introduction

As the incidence of cancer in adults aged ≥65 years continues to rise, so does the complexity of management. Comprehensive Geriatric Assessment (CGA)-led interventions have demonstrated a reduction in treatment-related complications and unplanned hospital admissions, support appropriate treatment decision-making and improve quality of life. We evaluated the implementation of CGA through a new Oncogeriatric clinic in optimising older adults undergoing assessment for surgery and/or chemotherapy with colorectal or hepatobiliary malignancy.

Methods

We conducted a retrospective audit of patients aged ≥65 referred for CGA at a large UK NHS Trust between March-December 2025. Data collected included demographics, cancer diagnosis, problems identified, interventions delivered, and clinical outcomes. Frailty was assessed using the Rockwood Clinical Frailty Scale(CFS) and referrals correlated against the Geriatric-8(G8) screening tool.

Results

Of the 47 patients reviewed, 28 were referred from colorectal and 19 from hepatobiliary services. Median age was 76 years (range 66–88) and 45/47 patients had a Charlson Comorbidity Index(CCI) score ≥5, indicating high burden of comorbidity.

Assessment demonstrated moderate-to-severe frailty (CFS ≥5) in 10(21.3%), pre-frailty (CFS 4) in 10(21.3%) patients.

Across the cohort, 148 problems were identified with a mean of 3.1 problems per patient (including suspected cognitive impairment, mood disorders, continence issues.) New diagnoses were made in 36 patients. Overall, 271 interventions were delivered, with most patients receiving between 4-6 interventions. Medication optimisation accounted for 22 interventions. Specialist referrals were implemented in 16 patients, whilst bone health investigations were undertaken in 12 patients.

At follow-up, 29 patients proceeded to surgery, 9 did not proceed (either too frail or declined) and 3 died during the audit period. 

Conclusion

Implementation of a dedicated Oncogeriatric service facilitated optimisation of older adults prior to cancer treatment, informed treatment decision-making, and identified unrecognised geriatric syndromes/medical conditions. CGA provides a holistic framework for assessment, intervention and personalised discussions regarding care goals and priorities.