Abstract
Over the last 12 months, an oncogeriatric clinic was successfully established to assess frail 2-week wait (2WW) patients referred with upper and lower gastrointestinal (GI) symptoms. The clinic was initially funded by the West Yorkshire Cancer Alliance, enabling a weekly clinic, run by a geriatrician, clinical specialist nurse and an advance clinical practitioner. A total of 350 patients were assessed, with only a third of them remaining on the 2WW pathway compared to traditional surgical patients; this was due to patients being too frail or an alternative diagnosis being made through comprehensive geriatric assessment, and a shared decision-making process. Patients with a clinical frailty score of 6 or more were eligible for referral, and due to demand exceeding capacity, remaining patients were referred on through the default surgical or GI pathways. Patients were triaged by endoscopy nurses from ‘straight to test’ referrals after training provided to assess frailty scores using routinely data available. The patient level information and costing system (PLICS) demonstrated that the oncogeriatric was a cost effective clinic, costing approximately £340 less per patient than the default pathways of care. Feedback from patients demonstrated extremely high satisfaction rates with the service provided. One of the most significant interventions was medicines management, which has led to a pharmacist supporting the clinic through further innovation funding. Lessons learned included developing a better understanding of cancer diagnosis and frailty, providing a ‘one stop centre’ for cancer care, and managing complex comorbid conditions in frail older people suspected of having cancer. As a result of this QI service development project, a Frailty Cancer Strategy for the Trust has been developed and will be presented to the executive team with the aim of developing a comprehensive oncogeriatric service for frail patients in Leeds, providing the right care, and right treatment first time.
Comments
Question on Triaging
We are on the verge of starting a oncogeriatric clinic. Your choice of GI malignancy is interesting. Were the triage nurses as you mentioned the endoscopy nurses formally trained in CFS?
We do plan to start similar services but our plan was hinging of Prostate CA patients. Have you had any experience with other malignancies at your clinic?
Response to Triaging question
Thank you for your question. Yes, the endoscopy nurses were given formal training in using the Rockwood Clinical Frailty Score, so that they could triage the patient's CFS prior to coming to clinic. The triage process however is reliant on there being sufficient information in the referral details, to be able to determine the patient's degree of frailty using the Rockwood Clinical Frailty Score. But globally, we do feel that we are seeing the most frail patients in this clinic, so the triaging process appears to be working well.
The clinic currently is focussed only on upper and lower GI malignancies, through streaming from the upper and lower GI 2 week wait pathways. However, following from the positive work in this clinic there is now a real interest from Cancer Alliance in Leeds to expand these services through to other cancer pathways, so this is something that we very much hope to pursue in the near future.