Poon 25/3/09 12:07 pm Page 67
Geriatric Oncology
Challenges in the Practice of Geriatric Oncology in a
National Comprehensive Cancer Centre in Asia
a report by
Donald Poon
Consultant Medical Oncologist, Department of Medical Oncology, National Cancer Centre Singapore
As an industrialised nation, Singapore shares similar societal and nutritionists, physiotherapists, occupational therapists and social
healthcare concerns with other developed countries. It has a multiracial workers. These collaborators are from SGH. Monthly research meetings
society comprising different ethnicities: 75% Chinese, 14% Malays, 9% and talks are held to co-ordinate all research activities within geriatric
Indians and 2% Eurasians and other groups. The twin emergence of an oncology, discuss new research ideas and also to provide a platform for
ageing population and cancer as the leading cause of mortality has led the various specialties to share new insights. The NCCS largely
to the burgeoning increase in the population of elderly patients with funds the geriatric oncology programme, with a significant proportion
cancer. In Singapore, the number of elderly people older than 65 years from private philanthropy supporting clinical research.
of age as a percentage of the general population is projected to increase
from 6.8% in 1995 to 20% by 2030, and cancer disproportionately The Comprehensive Geriatric Assessment
affects more of those who are 65 years of age or older. At the National The outpatient geriatric oncology clinic is where patients who are older
Cancer Centre Singapore (NCCS), patients aged 70 years or older than 70 years of age with all diagnoses of cancer are referred and
account for about 40% of the 130,000 clinic attendances per year. In managed. Prior to the consultation with the medical oncologist, the
December 2006, a geriatric oncology programme was launched by the nurse programme co-ordinator will perform the Comprehensive
NCCS as a seminal framework to support research and clinical service Geriatric Assessment (CGA). The CGA entails collecting information on
development and to address the multifaceted challenge of managing an individual’s personal and social profile, including family support,
the elderly with cancer. physical performance using hand-grip strength, ‘get up and go’,
functional status recorded using the Eastern Co-operative Oncology
The National Cancer Centre Singapore Group (ECOG) scale, instrumental activities of daily living (IADL) and the
Geriatric Oncology Programme Katz index of activities of daily living, co-morbidity using the Charlson
The programme comprises outpatient and inpatient components, with risk index, affective domain using the geriatric depression scale,
a clinical research agenda interweaved into the service. The outpatient cognitive domain using the clock drawing test, the abbreviated mental
clinic in the NCCS is staffed by a medical oncologist and a nurse test, the mini-mental state examination (MMSE), the care-giver burden
co-ordinator. There are plans to hold a joint geriatrician–oncologist interview, the mini-nutritional assessment test and polypharmacy.
clinic for management of complex cases at NCCS. All NCCS oncology
patients are admitted to Singapore General Hospital (SGH) at the Challenges Faced
Outram Campus, which hosts a number of national healthcare centres Many professionals worldwide with similar clinical and research
under the management of the parent organisation SingHealth. On interests share the problems encountered by the Singapore team in the
average, there are 80 oncology patients in the ward at any one time. A management of the elderly with cancer.
1
These concerns include
weekly multidisciplinary round for selected elderly cancer patients with accumulating but still relatively limited systematic data in geriatric
challenging problems is held in the oncology ward with geriatricians, oncology, partly due to under-representation of the elderly in oncology
palliative care physicians, nurses and related health professionals, i.e. trials, a bias towards understaging and undertreatment in the
elderly and a lack of understanding of the impact engendered on
treatment outcomes in these patients through the interaction between
Donald Poon is a Consultant Medical Oncologist in the
geriatric syndrome, co-morbidity and diagnosis of cancer. Some of the
Department of Medical Oncology at the National Cancer
Centre Singapore (NCCS), which he joined in 2001. His
more pertinent challenges in terms of the Asian situation are
specialty interests include geriatric oncology,
highlighted below.
gastrointestinal and hepatobiliary cancers and sarcoma. He
is a Clinical Teacher at the Yong Loo Lin School of
Medicine in the National University of Singapore (NUS) and The Research Agenda – Global Vision and
is Practice Course Leader as a member of the clinical
Partnerships Providing Local Solutions
teaching faculty in the Duke-NUS Graduate Medical School.
He is National Representative for Singapore in the International Society of Geriatric Oncology
The formulation of a rational and cost-efficient research programme is
(SIOG) and President of the Society of Geriatric Oncology in Singapore. He initiated the the lynchpin of solutions provision in the geriatric oncology practice.
Geriatric Oncology Programme for the NCCS. He was awarded the Healthcare Humanity
The NCCS geriatric oncology programme, which is a work in progress,
Award (2006) and the STAR Excellent Service Award (2007) in recognition of his work. Dr
Poon’s clinical research work has been published in various international oncology journals,
recognises that assessment and care for the elderly cancer patient is
and he has been involved in many initiatives in patient support and care, cancer screening,
currently far from ideal. The practice of geriatric oncology in Asia can
public health education and community outreach projects.
only be advanced through collaboration with global partners in the US
E:
dmopyh@gmail.com
and Europe: being pioneers in this field these partners generously serve
as excellent mentors in the learning process. The NCCS programme was
© TOUCH BRIEFINGS 2008 67
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100