The Older People's Project pilot sites

We are working in partnership with the Department of Health and Age UK on a project to address under-treatment of older people with cancer.

Read the project report Cancer Services Coming of Age [PDF2.6MB].

In 2011, 14 NHS Trusts throughout England began to test new models of care for older people aged 70 and over, including:

  • testing new methods of clinical assessment of older people with a diagnosis of cancer
  • coordinating and delivering short-term practical support packages for older people undergoing treatment
  • promoting age equality to address age discriminatory behaviour in cancer services.

A final report from the pilot sites will be available in December 2012.

Why do we need better assessment methods?

Two older people with cancer may be the same chronological age but have different physiological ages.

One older person interviewed for the recent Macmillan Walking into the Unknown report [PDF] said:

'I asked my [specialist nurse] about the decision on my treatment to have the injections. She brought my file in and showed me a letter that had been signed by four consultants. It said that "due to the patient being 85 we recommend hormone treatment".

When it’s in black and white like that, and maybe I’m anticipating it, but I’m sure if I was 65 I’d be on a different treatment. I’ve always been really active; I’m not necessarily a typical 85 year old.

It’s like she’d gone beyond her duty and was showing me something that maybe I shouldn’t have seen. It was like she was giving the game away, and it was at that point that I thought for the first time: this is palliative, not curative.’

What would better assessment methods achieve?

Half of all cancers occur in people aged 70 or over. In the case of some older people with cancer, curative treatment won’t increase the quality or length of their life, and may be harmful. So, older people commonly receive less aggressive therapies.

We hope assessment methods routinely used in geriatric medicine will be adopted in cancer services to support clinicians and patients to make more appropriate treatment decisions.

This may lead to identifying more older people for whom curative treatment would be appropriate, and reduce the number of people denied treatment on the basis of their chronological age.

Furthermore, these assessments may identify health problems which can be managed in order to improve treatment tolerance.

What difference will practical support make?

Our aim is to reduce the number of older people who refuse cancer treatment because they don’t feel they'll be able to maintain their independence and cope at home as a result of it. Practical support may include activities such as providing transport, housekeeping, shopping, dog-walking and befriending.

The pilot project will see greater collaboration between acute care, primary care, social services and the voluntary sector to ensure older people receive practical support during treatment.

The pilot sites

Merseyside and Cheshire Cancer Network

Clinical assessment

Merseyside and Cheshire Cancer Network is testing new methods of assessment and support in three NHS trust pilot sites.

These pilot sites are trialling a method of pre-operative assessment, called 'PREOP', in cancer patients aged 70 and over. Clinical Nurse Specialists (CNSs) at the pilot sites conduct 30 minute interviews with each patient to assess their fitness for cancer treatment. This study aims to see whether tools including the vulnerable elders survey 13 (VES-13), can predict how well a patient will cope with surgery.

Practical support

Following the assessment, the CNS will offer patients practical and emotional support to cope at home during their treatment. Older cancer patients who feel they need support are referred to local Age UK and Age Concern services.  Volunteers from Age UK provide support in the form of befriending, shopping, cooking, cleaning and more. In providing short term practical support for older people, Age UK volunteers aim to enable older people to feel more physically and emotionally able to cope with cancer treatment.

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North East London Cancer Network

Clinical assessment

There are five acute trust pilot sites in the North East London Cancer Network working to improve outcomes for older patients with a diagnosis of colorectal or breast cancer.

Read their Final Project Report [PDF].

Cancer Clinical Nurse Specialists(CNSs) in these trusts have been trained to undertake a comprehensive geriatric assessment of their older patients following diagnosis. The assessment, lasting up to 60 minutes, aims to identify issues which can be managed to ensure patients are as fit as possible for their treatment. Treatment plans will be discussed with patients in an outpatient setting and once the patient agrees; the treatment will begin. Geriatricians are also being involved in the management of older patients.

Practical support

North East London Cancer Network has also set up referral pathways to the local Age UK and Age Concern, who will provide practical support services to the older patients during their treatment. CNSs refer patients to Age UK / Age Concern for services such as befriending, shopping, cooking or cleaning as well as other practical and emotional support. Most services are provided by volunteer ‘buddies’, trained and managed by Age UK.

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South East London Cancer Network

Clinical assessment

South East London Cancer Network are piloting a Geriatric Oncology Liaison Service which consist of a Consultant Geriatrician (0.2FTE), a Specialist Registrar in Geriatric Medicine (1.0FTE), and a Macmillan Clinical Nurse Specialist (0.8FTE). This is run from the Older People’s Assessment Unit at Guys and St Thomas’ NHS Foundation Trust (GSTT).

Following diagnosis, older patients are sent a self-assessment questionnaire to complete and return to the centre. The questionnaire asks about quality of life, activities of daily living and other health problems such as shortness of breath or hypertension. The Clinical Nurse Specialist (CNS) contacts each patient via telephone to discuss the questionnaire and invites those with complex needs to visit the clinic for a full Comprehensive Geriatric Assessment (CGA).

During the CGA, the Geriatrician will identify any issues with treatment including comorbidities, polypharmacy or continence problems. The healthcare team will then look to address these issues to ensure the patient is as fit as possible before they start their treatment. The Geriatrician and the CNS work closely with surgeons and oncologists to support treatment decision making.

GPs from Bexley Care Trust are working in partnership with this service and patients from Bexley are followed up by local GPs as opposed to attending the Older People’s Assessment Unit.  

Practical support

All patients involved in this pilot are given a directory produced by the Geriatric Oncology Liaison Unit which details local practical support services which can provide assistance to patients during their cancer treatment.

Patients are contacted by the CNS during their treatment to see if they are accessing practical support and if they need assistance in doing so.

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Sussex Cancer Network

Clinical assessment

Sussex Cancer Network pilot sites are running two studies. The first is around clinical assessment and the second around practical support.

For the assessment study, Sussex pilot sites are testing whether instruments such as the vulnerable elders survey 13 (VES-13), undertaken as part of a Comprehensive Geriatric Assessment, can predict how well colorectal cancer patients will tolerate chemotherapy.

Practical support

The pilot sites in Sussex are running a Chemotherapy Enhanced Support Programme for patients over 70 with breast, lung, colorectal or urological cancer. This study aims to assess the impact of providing practical support to older people undergoing chemotherapy.

Patients are referred to the local Age UK service, and following an assessment, are offered up to two hours per week of practical or emotional support, for up to six months. Support services could include gardening, cooking, cleaning, transport, befriending, and so on.

It is hoped this support will increase the proportion of older people who complete their chemotherapy, who remain independent and supported in their own homes and avoid the need to be re-admitted to hospital.

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Thames Valley Cancer Network

Clinical assessment

The Royal Berkshire NHS Foundation Trust have established a pilot Geriatric Oncology Liaison Service named CoCoC - Comprehensive Care for Older people with Cancer.  The service consists of a Consultant Geriatrician (0.2FTE), a Specialist Registrar in Geriatric Medicine (1.0FTE) and a Clinical Nurse Specialist (0.8FTE).

All older patients are assessed using a Comprehensive Geriatric Assessment, often in the patients own home. Issues such as malnutrition and cognitive impairment are identified are managed as appropriate before treatment begins. The service also works closely with surgeons and oncologists to support treatment decision making. 

Practical support

The service have partnered with the Red Cross to set up a 'buddy service' for older people undergoing cancer treatment.  All older patients are offered a buddy to provide practical and emotional support during cancer treatment.

Once the Red Cross receive the referral from the service, the coordinator will make contact with the patient, arranging a visit to discuss their needs.  The coordinator will carefully match a volunteer buddy to the patient. Services include transport, assistance with prescriptions, forms, grant applications, assistance with meal preparation and cleaning and so on, depending on the patients needs.

The Red Cross buddy service aims to support older people in their own homes so they are able to maintain their independence and be as fit as possible during and after their treatment.

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