This article was downloaded by: [Michigan State University] On: 16 February 2015, At: 06:01 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Psychosocial Oncology Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wjpo20

Is It Helpful to Give Older People with Cancer the Same Chance at Rehabilitation as Older General Medical Patients? a

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C. Lethborg PhD, MSW, BSW , R. Brown RN, MN , S. Posenelli BA, a

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DipEd, BSW, MSW , L. Pollerd BA, BSW , S. Wigg BPhed, BOccTher, c

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MHA , C. Challis BAppSc, Grad Dip Rehab Studies, MBA , A. Hocking b

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BSW & C. Whitehall BPhysio a

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Department of Social Work, St. Vincent's Hospital, Melbourne, Australia b

Department of Social Work, Peter Mac Callum Cancer Centre, Melbourne, Australia c

St. Vincent's Sub-acute Ambulatory Care Services, Melbourne, Australia d

Department of Physiotherapy, St. Vincent's Hospital, Melbourne, Australia Accepted author version posted online: 02 May 2014.Published online: 02 Jul 2014.

To cite this article: C. Lethborg PhD, MSW, BSW, R. Brown RN, MN, S. Posenelli BA, DipEd, BSW, MSW, L. Pollerd BA, BSW, S. Wigg BPhed, BOccTher, MHA, C. Challis BAppSc, Grad Dip Rehab Studies, MBA, A. Hocking BSW & C. Whitehall BPhysio (2014) Is It Helpful to Give Older People with Cancer the Same Chance at Rehabilitation as Older General Medical Patients?, Journal of Psychosocial Oncology, 32:4, 396-412, DOI: 10.1080/07347332.2014.917141 To link to this article: http://dx.doi.org/10.1080/07347332.2014.917141

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Journal of Psychosocial Oncology, 32:396–412, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0734-7332 print / 1540-7586 online DOI: 10.1080/07347332.2014.917141

Is It Helpful to Give Older People with Cancer the Same Chance at Rehabilitation as Older General Medical Patients?

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C. LETHBORG, PhD, MSW, BSW, R. BROWN, RN, MN, and S. POSENELLI, BA, DipEd, BSW, MSW Department of Social Work, St. Vincent’s Hospital, Melbourne, Australia

L. POLLERD, BA, BSW Department of Social Work, Peter Mac Callum Cancer Centre, Melbourne, Australia

S. WIGG, BPhed, BOccTher, MHA and C. CHALLIS, BAppSc, Grad Dip Rehab Studies, MBA St. Vincent’s Sub-acute Ambulatory Care Services, Melbourne, Australia

A. HOCKING, BSW Department of Social Work, Peter Mac Callum Cancer Centre, Melbourne, Australia

C. WHITEHALL, BPhysio Department of Physiotherapy, St. Vincent’s Hospital, Melbourne, Australia

Although the complexity of age combined with a cancer diagnosis can result in unmet supportive care needs there are seldom resources to assess or address such needs for older people with cancer (OPWC). The purpose of this project was to trial a service to improve the care for OPWC through (1) an expanded supportive care screening process and (2) capacity building of subacute ambulatory care services (SACS) staff to increase referrals to community-based rehabilitation. Methods/design: Collaboration between allied health (AH) staff at an inner city general hospital with a large cancer service, a cancer specialist hospital, and a SACS service in Melbourne, Australia, developed an AH geriatric screening assessment (GSA) tool. Parallel to this process training was provided to SACS staff in relation to working with OPWC. Although close to one half (44%) of SACS staff who participated in this program (n = 22) had over 6 years’ experience, 32% had not worked with OPWC. Prior to training, 81% did not feel confident in their knowledge about

Address correspondence to C. Lethborg, PhD, MSW, BSW, Oncology Department, St. Vincent’s Hospital, Fitzroy, Victoria, Australia 3104. E-mail: [email protected] 396

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working with this cohort. After their training 72% were more confident about normal aging and implications for care of OPWC. Of the 491 patients screened, 80% were older than age 65, however, only 25 resided in the SACS catchment area. More than one third of these did not have clear rehabilitation needs, and the remainder were not referred due to ongoing medical issues. Less than one half of the patients in the catchment area were discussed in a Multidisciplinary Meeting (MDM) but all were referred to allied health and assessed using the GSA. Although this project did not result in referrals of OPWC to SACS the training program for SACS staff was a success and allied health assessments were improved to include GSA factors. The complexity of care for OPWC was further highlighted through interviews with staff involved with the study. KEYWORDS older people with cancer, rehabilitation for older cancer patients, ambulatory care for cancer patients, allied health collaboration, service planning

INTRODUCTION Cancer is a disease of aging. In 2003 the median age of patients diagnosed with cancer in Australia was 67.8 years with 44% of patients age older than 70 at diagnosis (Evans, 2008). Recently the Australian Institute of Health and Welfare (AIHW; 2006) revised its formula for lifetime risk of a cancer diagnosis from one in three for men and one in four for women by age 75, to one in two for men and one in three for women by age 85. Indeed, as the population continues to age, this trend threatens to compete with the propensity toward a declining incidence of cancer overall. Paradoxically, older people with cancer are generally underrepresented in clinical research, the over 75 age group, for example, are notably absent in many clinical trials resulting in the effectiveness of many cancer treatments being unlikely to be based on sound scientific evidence for this age group. Ershler (2003) claimed that older people do not receive the same “quality” of cancer care as younger people and that the elderly cancer patients tend to survive a shorter time than their younger fellow patients. Although there is no evidence to suggest that older people cannot tolerate the same intensity of anticancer treatments, the extent to which tumors are diagnosed, treated, and staged is less in this age group than in that of younger people with the same disease (Turner, Haward, Mulley, & Selby, 1999). In addition, the majority proportion of older people living with cancer is also not reflected in many of our service planning, clinical trials, intervention studies, or even the proportion of people offered cancer treatments (Lichtman et al., 2007). Assumptions about older cancer patients often arise

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from stereotypes, and yet there may be specific care needs peculiar to this group. Research to date has largely centered on epidemiological or descriptive studies (Extermann, 2010, Schrijvers et al., 2010). However, the dual complexity of aging and cancer would suggest that supportive care needs such as difficulties with mobilization, performing activities of daily living (ADLs), mood, and social supports require a particular focus. For more than 20 years the call for specific research into the needs and concerns of this majority proportion of the cancer population has been repeatedly made. In 1988 the presidential address at the American Society of Clinical Oncology meeting focused on the need to study aging and cancer. In 2007 the Journal of Clinical Oncology set a research agenda into this area of cancer care (Lichtman et al., 2007). In 2008 the Clinical Oncology Society of Australia held a workshop to bring together experts in oncology and geriatrics from across the country. This group focused on what it referred to as “an unprecedented challenge” where cancer in the elderly and its mortality rate was found to be on the rise. The risk of dying from cancer was noted to have increased from one in 24 to one in three for people older than age 60 (AIHW, 2006). Given these inextricable links, the lack of crossover or cooperation between the disciplines of oncology and aged care has been unfortunate. What has been called for is a targeted approach to care of the older cancer patient. This study brought together a research team of allied health staff from a range of professions and from the cancer and aged care settings. The research team worked in a large metropolitan general hospital (GH) specialising in aged care and cancer, a cancer specialist hospital (CH) and a community-based subacute ambulatory care service (SACS). The overall focus of this team was to investigate options for supportive care pathways for older people with cancer (OPWC).

SUPPORTIVE CARE FOR OPWC An audit was conducted at the GH of the documentation of supportive care needs for 36 cancer patients attending multidisciplinary meetings (MDM) who were age 70 years and older. These patients were randomly selected using a biased-coin randomization method. Documented assessments of supportive care needs were recorded for physical, functional, nutritional, social, psychological, and cognitive domains. Nine tumor streams were represented with 48% of patients having an inpatient episode within 6 months of their MDM. Of the 36 patients, 12 (33%) received an Allied Health referral. There were a total of 25 (69%) patients that had no documentation of vision, hearing, falls, cognition, or psychological status. Fifteen (42%) of patients had no documentation of mobility or ADLs details.

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The audit identified a service gap in the assessment of supportive care needs of older cancer patients and supported the need to review current practices for this patient group and to trial a supportive care pathway with an aim to improve care.

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AIMS AND OBJECTIVES This project aimed to improve the provision of supportive care services and resources to support OPWC with complex care needs through targeted assessment and referral to SACS in two metropolitan health services. The objectives included: • To implement a geriatric screening assessment (GSA) to identify OPWC who may benefit from supportive care • To develop referral processes from the acute setting to SACS for OPWC. • To build capacity in SACS to improve the ability of staff to provide appropriate care for OPWC.

METHOD The project had three phases. 1. Capacity building to ensure that SACS staff were confident in managing supportive care needs of OPWC 2. Developing assessment tools required to identify OPWC who may benefit from SACS. 3. Trial the assessment/referral process for OPWC to identify supportive care needs of OPWC and refer to SACS.

Phase 1: Capacity Building All staff in the SACS attached to the GH were invited to participate in training to improve care for OPWC, and the majority (21/29 or 72%) agreed. This group was made up of a range of allied health staff as illustrated in Table 1. Although this group included experienced health professionals (more than 71%; n = 15) had more than 25 years’ experience in SACS), 24% (5/21) said that they had not worked with OPWC, and the majority (81%; n = 17) did not feel confident about their knowledge in working with this group. To match the training program to the SACS staff specific needs, a learning needs survey was developed and completed by all staff who had indicated an interest in the training. The learning needs survey was offered

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TABLE 1 SACS Staff Participants by Profession, Gender, and Experience Characteristics

Is it helpful to give older people with cancer the same chance at rehabilitation as older general medical patients?

Although the complexity of age combined with a cancer diagnosis can result in unmet supportive care needs there are seldom resources to assess or addr...
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