Never too old to learn new tricks: surveying Canadian health care professionals about learning needs in caring for older adults with cancer.

Abstract

Cancer is the leading cause of death in Canada1. More than 60% of Canadians diagnosed and more than 70% of those dying of cancer are 65 years of age or older. Aging of the population means that the proportion of those 65 years of age and older is expected to increase to 27% by 2050, and the cancer incidence is projected to increase by 79% between 2003 and 20301. Older adults often have numerous medical conditions (“multimorbidity”), and many older patients take several medications daily, both of which influence cancer treatment tolerability and outcomes. The current available evidence with respect to how to best care for older adults with cancer has gaps because of underrepresentation of the older population in research. Older adults currently experience both overtreatment and undertreatment, which affects cancer outcomes and health care resource consumption. In addition, oncology care providers might not be adequately prepared to identify issues of health and well-being that can affect cancer treatment decisions or treatment delivery in older adults. For example, unaddressed cognitive impairment can impede a person’s ability to adhere to oral medication regimens, to attend treatment appointments, and to appropriately judge when to reach out to health care providers in case of symptoms—all while lowering life expectancy. It is therefore crucial that all health care providers have basic geriatric knowledge and skills to care for older patients. The 2018 American Society of Clinical Oncology Geriatric Oncology guideline recommends that geriatric assessment should be implemented for older adults (70 years of age and older) for whom chemotherapy is planned2. It recommends that, at a minimum, geriatric assessment should evaluate function, comorbidity, falls, depression, cognition, and nutrition. Such an evaluation requires knowledge and basic expertise in geriatrics for all health care providers. Most health care providers have not received sufficient training in geriatrics3–5. Geriatric oncology is an even newer area of expertise. A survey of Canadian radiation oncology residents showed that 73% had geriatric oncology learning needs6. An American Society of Clinical Oncology survey of Canadian and U.S. hematology–oncology fellows also showed limited training in geriatrics and geriatric oncology, although most respondents expressed an interest in enhancing their geriatric oncology knowledge and skills7. No similar national surveys of other Canadian health professionals have been conducted. However, other health professionals are likely not to have received adequate training in caring for older adults with multiple chronic conditions, numerous medications, and psychosocial issues. The available numbers of geriatric experts, such as geriatricians and geriatric nurses, to care for all older Canadians with cancer are insufficient. We therefore believe that there is a need to enhance the knowledge and expertise of all health care providers about how to appropriately care for older adults with cancer. In 2016, we established the Canadian Network on Aging and Cancer8 to foster national collaboration that will enhance clinical care for older adults with cancer through research and education. At the 1-day inaugural workshop in 2016, several short-term and long-term education priorities were identified by the attendees present, including development of interprofessional geriatric oncology education based on the learning needs of Canadian health care providers. Thus, to assess geriatric oncology learning needs, we invite all Canadian health care providers involved in the care of older adults with cancer to participate in a survey to examine their learning needs. Please consider completing the survey no matter when or where you see older adults in their cancer journey—from diagnosis to treatment, to survivorship, to end of life, and in hospitals or community settings. The Canadian Network on Aging and Cancer and the Oncology and Aging Special Interest Group of the Canadian Association of Nurses in Oncology are aiming to develop education resources addressing the needs identified from the findings of the survey.