Fitness assessments used in geriatric care benefit cancer patients, pilot studies find

BMJ 2012; 345 doi: (Published 21 December 2012) Cite this as: BMJ 2012;345:e8655
  1. Gareth Iacobucci
  1. 1BMJ

Older patients with cancer should undergo comprehensive assessments of their existing medical conditions, physical wellbeing, mental health, and social care support to safeguard against “discriminatory” treatment recommendations, a new report has concluded.

The Cancer Services Coming of Age report gives results from government pilots that tested whether better methods of assessment of health and care would improve access to treatment for older people with cancer. The pilots found that the “comprehensive geriatric assessment” could “impact positively on treatment decision making and general quality of care” if used in care of patients with cancer.1

The pilots, established in January 2011, took place in five cancer networks in England: Merseyside and Cheshire, Thames Valley, North East London, South East London, and Sussex.

The assessment—commonly used in elderly care medicine but not in other specialties—could help the NHS meet its legal obligation to ensure that there is “no direct or indirect discrimination” in the delivery of cancer services to older people, as set out in the Equality Act 2010, said the report. It was published by the Department of Health in conjunction with Macmillan Cancer Support and Age UK.

It also found that employing specialists in elderly care in “both planning and delivery” of cancer services for older patients could improve the scope for them to benefit from treatment. It urges cancer service providers and commissioners to engage specialists in the process. Using the assessment and involving elderly care specialists could make a “significant difference” to older patients in making decisions about treatment and not having those decisions made for them, the report said.

It said that there was “robust evidence” that the assessments were “highly beneficial in the older population at large,” though it acknowledged that further research was needed “to quantify the impact these interventions have on cancer outcomes.”

Key points of advice for providers and commissioners include that “treatment recommendations should never be made on age based assumptions” and a reminder that services must be designed with older people in mind.

It said, “The majority of people who use cancer services are older people. Service provision that disadvantages those with needs commonly associated with ageing may be an act of indirect age discrimination.”

It advises researchers to continue to test assessment methods to ensure that “older people with less obvious needs are not disadvantaged.”

The report concluded: “There is a compelling argument to improve cancer care for older people. Cancer is predominantly a disease of older age. Not only do the recent changes to the Equality Act place a legal duty on cancer services to ensure this age group are not unduly discriminated against, significant steps must be undertaken to improve cancer outcomes and improve the efficiency of services.”


Cite this as: BMJ 2012;345:e8655