Nurses Play Key Roles in Geriatric Cancer Clinics

Oncology and advanced practice nurses are key players in developing and managing specialized clinics that combine geriatrics and oncology care, according to a recent study. The clinics are being established at major cancer centers in an effort to better manage the complex needs of older patients.

Developing a Geriatric Oncology Ambulatory Care Clinic (GOACC) is more complicated than just adding assessment tools to the visit, note the authors of a review published in the Clinical Journal of Oncology Nursing. The clinics must be staffed by multidisciplinary teams experienced in geriatric care and have the infrastructure to support complex scheduling and longer patient encounters.

“Geriatric oncology care is a layered process that requires expertise, considerable patience, multiple resources, and fastidious communication with general practitioners, other medical teams, and family members,” the authors wrote. “Not all problems can be solved or even evaluated during one visit to the clinic. Patients and families must be committed to making multiple office visits, adhering to team recommendations, and consulting with specialists, such as physical therapists and mental and cognitive health professionals.”

One of the barriers to developing a GOACC is creating a multidisciplinary team with the necessary experience in caring for older adults, they said. Forming a team of physicians, nurses, social workers, physical therapists, pharmacists, and dietitians often requires extensive negotiation with administration for allocation of resources and time.

Primary care nurses and nurse practitioners often take on the role of clinic coordinator, responsible for directing team members, compiling data from comprehensive geriatric assessments, and facilitating team discussions, the authors said. It’s important that the coordinator receive protected time to devote to organizing the team, assembling patient data, and communicating with patients and families.

The study identified several other core elements of developing a sustainable geriatric oncology ambulatory care clinic:

Managing comorbidities. Patients older than 70 typically have multiple diagnoses that, if left untreated, can increase the risk of chemotherapy toxicities. Addressing nonmalignant issues can help lay the foundation for cancer treatment and reduce complications, such as congestive heart failure or cardiomyopathy. Patients should be encouraged to continue seeing other providers for pre-existing comorbidities while those who develop comorbidities after their cancer diagnosis should be referred to disease-specific services.

Conducting a comprehensive geriatric assessment (CGA). The CGA is a comprehensive evaluation that addresses issues specific to older patients, including physical reserve or resiliency from health problems, and life expectancy. The assessment also addresses dementia and delirium, incontinence, depression, and functional status limitations. Patients who are older, taking multiple medications, or who have multiple comorbidities are more likely to benefit from the CGA than healthier patients.

Providing caregiver support. Encouraging caregivers to maintain their own physical and emotional health is critical to continuing their caregiver role. The clinic team should listen to caregivers’ concerns and encourage them to seek support. Caregivers should also receive education about the disease process, symptom management, and reducing symptom burden in patients.

Since nurses often coordinate geriatric oncology clinics, it is vital that they have input into their development and management, the authors noted.

“Nurses must be included in the development of the infrastructure to create sustainable clinics that work to address the needs of older adult patients with cancer,” they wrote. They “must participate in administrative discussions concerning the allocation of resources, as well as provide perspectives about clinic staffing and scheduling.”