To assess the feasibility of a therapeutic radiographer completing the brief geriatric assessment in lung cancer patients during routine radiotherapy practice

Abstract

Keywords: Frailty, Brief Geriatric Assessment (BGA), Primary Lung Cancer, Radiotherapy, Occupational Therapist (OT), Therapeutic Radiographer. Introduction: The number of older people living with cancer will treble by 20401. Age-related decline in health deems radiotherapy as an attractive treatment option for people with cancer compared with surgery or chemotherapy2. However, even low-grade side effects may significantly impact older patients3. BGA4,5 is a multidisciplinary assessment that identifies the medical, psychosocial and functional needs of older people. This project aimed to assess the feasibility of therapeutic radiographers undertaking the BGA5, identifying skills required and impact on the service and the patient pathway. Method and Materials: The researcher (a therapeutic radiographer) undertook measurements using a modified version of the BGA on 15 patients under guidance from an OT. The first nine patients were assessed under direct supervision and the remaining six independently. On completion of each assessment, the researcher liaised with the OT, together making decisions based on clinical reasoning as to appropriate interventions, such as referral to community support services like Macmillan Cancer Support, OT, physiotherapist, GP and social services. The primary measure of feasibility is the time taken and skills required to complete the BGA effectively. Results: 67% of the 15 patients were identified as having unmet needs, ranging from cognitive, psychosocial, fatigue and functional deficits. BGAs ranged from 20-90 minutes and an additional 60-300 minutes were spent undertaking actions post BGA. The longest time was spent with the patient on the palliative pathway. Examples of actions implemented: referral to community services for falls prevention, rehabilitation and psychological support. Due to complex needs, 33% of patients were directed to be case managed by the OT. Conclusion and Discussion: This exploration has highlighted challenges of time constraints and limited assessment skills in incorporating the full BGA into the current radiotherapy service in one large department. However, it is possible to adopt a universal, targeted and specialist strategy by incorporating a multidisciplinary working arrangement, where low level needs are addressed by upskilling radiographers and complex cases managed by appropriate allied health professionals. Such an approach could provide appropriate and timely interventions to enhance patient pathways. Numerical References [1] Maddams, J., Utley, M., & Møller, H. (2012). Projections of cancer prevalence in the United Kingdom, 2010–2040. British Journal of Cancer, 107(7), 1195-1202. [2] Borras JM, Lievens Y, Barton M, Corral J, Ferlay J, Bray F, et al. (2016). How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis. Radiotherapy and Oncology, 119(1), 5-11. [3] O'Donovan, A., Leech,M., Gillham, C. (2017). Assessment and management of radiotherapy induced toxicity in older patients. Journal of Geriatric Oncology, 8 (6), pp. 421-427. [4] Keenan, L. G., O'Brien, M., Ryan, T., Dunne, M., & McArdle, O. (2017). Assessment of older patients with cancer: Edmonton Frail Scale (EFS) as a predictor of adverse outcomes in older patients undergoing radiotherapy. Journal of geriatric oncology, 8(3), 206-210. [5] NHS ENGLAND MARCH 2017 DOCUMENT: Toolkit for general practice in supporting older people living with frailty. https://www.england.nhs.uk/publication/toolkit-for-general-practice-in-supporting-older-people- living-with-frailty.