Providing early access to geriatric oncology services in a regional cancer centre - A two-year experience in the establishment of a Geriatric Oncology Nurse Navigator Model

Introduction: Older patients with cancer often face increased risks of adverse reactions and complications when undergoing systemic therapy. In 2020, the Townsville Cancer Centre in North Queensland established a nurse navigator led geriatric oncology service for patients aged 75 years and above referred for systemic therapy for solid organ malignancy. This study sought to evaluate the safety outcomes and trends in the administration of systemic therapy in older patients following the introduction of this service.

Materials and methods: A retrospective study was conducted at a single centre, focusing on patients aged 75 years and above referred for chemotherapy or immunotherapy for solid organ malignancies. Patients referred after the implementation of the service were classified as the geriatric assessment cohort, while those referred before were categorized as the historical cohort. Outcome measures included unplanned hospital admissions, duration of hospital stays, rates of systemic therapy de-escalation, and frailty identified during geriatric assessments.

Results: The study included 129 patients, with 60 in the geriatric assessment cohort and 69 in the historical cohort. The geriatric assessment cohort exhibited a significant decrease in both the average number of hospital admissions per patient compared to the historical cohort (0.59 vs. 1.13, p = 0.01) and the average length of hospital stay (4.3 days vs. 6.7 days, p = 0.04). Rates of systemic therapy de-escalation were comparable between the two cohorts (47 % vs. 59 %, p = 0.16). Frailty was frequently identified during geriatric assessments, requiring intervention both before and during treatment.

Discussion: Our two-year observation of the nurse navigator-led geriatric oncology model suggests that it contributed to improved safety outcomes, leading to reductions in unplanned hospitalizations and lengths of hospital stays, without significant changes in the rates of de-escalated systemic therapy.