TCRN Conference Grant Series: Dr Christopher Steer, Border Medical Oncology

 TCRN Member Christopher Steer; Conference Grant recipient TCRN Member Christopher Steer; Conference Grant recipient

Supportive care screening in the older adult with cancer

The Multinational Association for Supportive Care in Cancer (“MASCC”) is the principle global organisation dedicated to this cause. Its motto is "supportive care makes excellent cancer care possible". MASCC is not only multinational but multidisciplinary. The core scientific work is led by 16 study groups in fields such as mucositis, infection/myelosuppression, psychosocial, palliative care, neurological complications, antiemetics, and paediatrics. The geriatric oncology study group was formed this year and I had the honour of being asked to co-chair the first meeting. The aim of this group is to improve supportive care specifically for older adults with cancer. We look forward to collaborating with other organisations such as the International Society of Geriatric Oncology to continue to foster education and research in this field.

The MASCC 2012 Symposium (June 28–30) provided insight into recent research in the management of issues such as neuropathy, bone health, psychological support and prevention of infectious complications. Key learnings that I took from this year’s meeting include: 

  1. Duloxetine has been found to be useful in the management of peripheral neuropathy but its impact seems to be restricted to improvement in pain associated with this condition, rather than numbness or paresthesia.
  2. A randomized trial of dexamethasone (4mg BD for 2 weeks) versus placebo demonstrated a significant improvement in fatigue in patients with advanced cancer.
  3. A study of oxygen therapy versus air flowing over patients' faces revealed that symptomatic relief from dyspnoea was achieved with air flowing over the face alone. This lead to the comment that use of a simple fan may be as effective as the more expensive option of domiciliary oxygen in patients with this symptom.

The beauty of attending a meeting like this is that the data presented has a wide applicability to my patient population. In this era of molecular medicine, where cancer is becoming a set of 1000 different rare diseases, it is a refreshing change to learn of research which can potentially be applied to all patients.

I attended this year’s MASCC Symposium to present our experience at Border Medical Oncology in supportive care screening. In collaboration with Cancer Australia and Hume Regional Integrated Cancer Service (RICS), we completed a pilot study of supportive care screening in all patients over the age of 70 presenting to our service. A questionnaire aimed at screening for supportive care needs and geriatric issues was sent to this group of patients who comprised 50% of all new patient referrals. Patients were then called by a cancer care coordinator who used the questionnaire as a guide for discussion of patient needs. This enabled streamlined referrals to existing community-based services in the cancer and aged care sectors.

We showed that this system using supportive care needs questionnaire and a cancer care coordinator was feasible and inexpensive ($42.40 per patient screened). A total of 73 referrals for supportive care services were made in the 155 patients screened in a 12 month period. Despite our initial fears, we found that we did not overwhelm existing community services (e.g. Home and Community Care and carer support) and they actually welcomed referrals from oncology directly. 

After presenting this data at MASCC, it became clear that this approach is relatively unique. Geriatric oncology is a small field globally and each centre approaches the management of their increasing population of older patients in a slightly different way. As distinct from units in teaching hospitals, our approach was tailored for a regional centre without the ready availability of in-house aged care services. A key aspect of our model is that these services in our region are already funded to provide care and happy to do so for patients in their own homes.

Our next challenge is to prove the efficacy of this model – a task requiring a large, Phase III randomized trial, probably with a cluster trial design. Under the lead of fellow TCRN colleague Professor Jane Phillips, we are currently exploring the feasibility of such a trial through the geriatric oncology interest group of COSA. We look forward to future endeavours in this field and welcome the involvement of interested TCRN members.

- Dr Christopher Steer

Dr Christopher Steer was recipient of a TCRN International Conference Grant for attendance at the annual Multinational Association of Supportive Care in Cancer (“MASCC”) symposia, held in New York in June 2012, where he presented the Border Medical Oncology and Hume RICS research: Care Coordination in the Older Adult with Cancer (CCOAC) – a pilot study of supportive care screening and intervention in an Australian regional oncology practice.

Christopher is a medical oncologist with Border Medical Oncology in Albury-Wodonga, and the lead clinician for geriatric oncology in the region. He is the inaugural chair of the geriatric oncology interest group of COSA.