Transcript Neoadjuvant chemotherapy in ‘technically inoperable

Care Coordination in the Older Adult with Cancer (CCOAC).
C.B Steer 1,, J.P.Donnelly 2,J O’Connor 2 . R.J.Myers 2, C.R.Underhill 1 , R.W.Eek 1,K. A. Clarke1, C.E.Packer 2
Border Medical Oncology, Wodonga, VIC, Australia1, Hume Regional Integrated Cancer Service, VIC, Australia 2,
This project is an initiative of Cancer Australia
funded by the Australian Government.
The aim of this project was to improve care
coordination and access to supportive care
options for people over 70 years of age with a
cancer diagnosis, and to develop a system for
routine supportive care screening of these
patients.
Background
As the median age of patients at
the first diagnosis of cancer in
Australia is 67 years, the majority
of patients can be considered
elderly.
The CCOAC project sought to
investigate the feasibility of the
routine screening of patients
over the age of 70 in a regional
community setting using the
“Adelaide screening tool”.
Screening vs Assessment
Screening is a brief process for
identifying the risk of having
supportive care needs.
Assessment is a more in-depth
process that confirms the
presence of supportive care
needs. (Dept of Health, Vic, Supportive Care guide)
Model
•The CCOAC tool (a revision of the
‘Adelaide Tool’) was provided to
patients, who then completed it at
home. This tool is a composite of
validated screening tools. Domains
include comorbidities, medications,
IADLs, social supports, cognition,
vision and hearing, distress & pain
scales and caregiver’s concerns.
•The Cancer Care Coordinator then
phoned every patient to clarify
supportive care risks
•Where a risk was identified patients
were referred to a community or aged
care service for further assessment and
referral. Some simple interventions
were provided on the phone e.g.
practical information and reassurance
•The carer was also interviewed
•The process was based in the Victorian
Service Coordination Framework to
ensure consistency with the broader
aged care and community sector
Conclusions
Results
• 91 patients participated in this pilot (50
males/41 females)
• 91 baseline screens were completed
•39x4 week screens were completed
•25 x8 week screens were completed
•Age range 70 – 94 (median = 77) years
•Average time of follow up phone call = 20
minutes
•There was no identified process for direct
referral to a GP from the CCC
•Patients who reported the process was a
positive experience = 99%
Number
Percentage
Patients receiving
an intervention
Where the patient
considered the
phone call itself to
be beneficial
Patients requiring a
referral
Total referrals all
destinations
Referrals to HACC
assessment (Home
& Community Care)
Referrals to
community allied
health
Referral to Carer
organisation
Patients identifying
feeling depressed
57
62%
69
67%
27
30%
Patients where
memory was an
issue
Patients unable to
identify their
tumour
stream/illness
8
9%
41
45%
34
6
7%
7
8%
8
9%
39
43%
 The model is feasible, accessible and
provides a clear message that it makes a
positive difference to a patient’s cancer journey
 The project developed a model which linked
patients to appropriate assessment by aged
care and community services
 It is possible to use existing community
based resources not previously accessed by
oncology services on a routine basis
 The needs of carers must be addressed
concurrently with the supportive care needs of
patients, particularly for this age cohort
 Engaging GPs within this model is
problematic and reflects this issue in the health
sector more broadly
 Health literacy, and the assumptions made
about health literacy of this patient cohort, has
an impact on the type of support sought and/or
accepted, and needs to be further addressed
 Ongoing and effective change management
and relationship building is key to sustainability
of this model. The Cancer Care Coordinator
position is consequently a critical component
For further information in relation to this project please
contact Jenny Donnelly or Jenny O’Connor
[email protected]
[email protected]