Press release posted July 2023
With an ageing population in the UK, The Christie in Manchester, one of the leading international cancer centres, has launched a new specialised service to support older cancer patients with complex needs and frailty.
The Senior Adult Oncology Unit is an outpatient-based service providing a range of assessments and support to help doctors and patients choose the most appropriate treatment options and enhance the support provided during such treatments, to improve care and achieve better clinical outcomes.
The new service is part of The Christie’s 5-year corporate strategy, with the Trust committing itself to develop a dedicated service to help meet the growing needs of an ageing population in close collaboration with the available services in the region.
Only a few cancer centres worldwide have dedicated services to support older patients with frailty. However, in 2018, The Christie was one of the first UK cancer centres to implement frailty assessments as part of the NHS Specialised Clinical Frailty Network.
The Senior Adult Oncology Unit was launched in 2022. The service started by supporting lung cancer patients at The Christie, a large group of patients typically diagnosed late in life. However, this service is rapidly expanding to other patient groups, such as patients with multiple myeloma and head and neck cancer.
The service is predominantly for patients over 70 with complex frailty who are being considered or already undergoing anti-cancer treatments, such as chemotherapy or radiotherapy. However, frailty may be found in some younger patients with cancer, and these may also be offered support.
The Senior Adult Oncology Unit is a multidisciplinary team comprising ten staff, led by Dr Fabio Gomes (consultant medical oncologist). The team includes a geriatrician, a GP with a special interest in geriatrics, a clinical nurse specialist, a clinical pharmacist, a dietitian, 2 occupational therapists, a physiotherapist and a service implementation lead.
They carry out specialist frailly assessments with patients, above and beyond a standard oncology assessment. The assessment looks at issues such as the patient’s resilience (physical and psychological), mobility, and risk of falls. It also considers the medications a patient takes, whether they can be safely reduced or optimised, and the implications of other health issues (co-morbidities) such as diabetes, heart disease or dementia.
The team uses the assessment findings to aid oncologists and patients in their decision-making regarding cancer treatment in particularly complex patients. It then offers a range of short and medium-term support measures to help patients during treatments to reduce the risk of complications. This might involve investigating and optimising other significant health conditions (co-morbidities), revising the (often large) number of medications, promoting exercises with a physiotherapist, adaptations recommended by an occupational therapist, dietary changes and enhanced support in the community. Patients with different kinds of cancer and conditions have different needs and may need different types of support.
This service currently runs 3 clinics a week, on Monday, Wednesday and Thursday afternoons. Where possible, patients are being seen by the Senior Adult Oncology team on the same day as other appointments at The Christie. Although predominantly an outpatient service, the team may also support some inpatients if they have already worked with them before hospital admission.
One of the patients at The Christie who has benefited from the new service is Jean Riding, age 75 from Dukinfield. The retired machinist, who has four children and seven grandchildren, was diagnosed with lung cancer in September 2022 after a persistent cough and loss of breath encouraged her to seek medical advice. A chest X-ray showed an area of concern and Jean was then referred for numerous tests and scans. “It was all a bit of a whirlwind,” said Jean. “Within a week they told me I had cancer, and a week after that I had been referred to The Christie and was starting chemotherapy at the beginning of October.
Due to various issues and complications including weight loss, mouth ulcers caused by chemotherapy, being lactose intolerant, muscle cramps, recurrent oral thrush and concerns about her bone density with risk of fractures, Jean was referred to the Senior Adult Oncology Service.
“The team has been great,” said Jean. “I lost weight during treatment as some food tasted horrible because of the chemotherapy and my calf muscles weren’t as strong as the team would have liked, so they arranged a bone density scan, gave me some exercises to do and provided me with dietary advice. I am now 2.5kg heavier thanks to them and my muscles are a bit stronger.
“I’d been having muscles cramps in my calves and toes, so they gave me some exercises and suggested iron tablets which have helped. I’m lactose intolerant, so the pharmacist found me liquid versions of all the medications I need, so I don’t have to take solid versions with lactose.
“I was worried about the side effects of chemotherapy and radiotherapy. They have given me a lot of reassurance and emotional support. I was also worried about having radiotherapy to my brain as I had an aneurism a couple of years ago. But they have done an MRI scan and that is showing there is no risk. The support they provided has given me the confidence to go through the treatment and they have put my mind at rest.
“I am so grateful to the Senior Adult Oncology Service for all their help.”
Dr Fabio Gomes, clinical director for the Senior Adult Oncology Unit at The Christie, said: “Older cancer patients with complex frailty, particularly those from deprived areas or patients who have other serious health issues alongside cancer, have less successful clinical outcomes. And patients with frailty are less likely to complete treatments like chemotherapy as planned.
“I am very excited to have launched this new service, and there is plenty of evidence that we can improve outcomes and shared decision-making for these older patients with frailty. This is a service to support patients and oncology teams.
“In fact, in recent years, we have seen several large, randomised trials, mainly in the USA, showing that frailty assessments and support can lead to a reduction in side effects from anti-cancer treatment and an improved quality of life for these patients.
“This service will hopefully enable more older and frail patients to benefit from treatments, which may be adapted, and complete these as planned, reducing unplanned hospital admissions and improving patient satisfaction and quality of life.”
This service was launched at The Christie’s Withington site, but it is planned to also support patients at other Christie centres in Oldham, Salford and Macclesfield in the near future.