Americans age 65+ suffer from what is commonly called the “Unders”: Under-assessed, under-enrolled, and under-treated in healthcare delivery. As a result, they are not always well understood – especially when cancer care is the topic.
As the Journal of Oncology Practice (2018) points out, chronological age does not always tell the story of a cancer patient. Fitness levels, family dynamics, cognition, coping skills, and pain tolerance may vary widely from patient to patient and greatly affect his or her ability to fight cancer.
Cancer assessment should reflect these nuances - and home care services are positioned to offer input and feedback to oncology teams, providing more complete and more precise cancer assessments.
Geriatric oncology + home care = More fully informed assessments
The Journal of Oncology Practice report (cited above) asserts that even though geriatric assessment is understood to provide relevant information for informing and guiding a course of treatment, it “is not routinely implemented in oncology practice as it is perceived to be time and resource consuming.”
However, an open channel between geriatric oncology teams and home care providers can lead to swift, holistic assessments for cancer patients receiving home care.
Assessment domains can be enhanced by home care input
The International Society of Geriatric Oncology (ISGO) offers an approach to assessment that includes self-administered or nurse-administered questionnaires in several “domains,” (Demographic and Social Status, Comorbidity, Polypharmacy, Functional Status, Cognition, Mood, Nutrition, and Fatigue), each requiring an estimated 10-20 minutes to complete.
In an integrated model of home care (in which nurse-led care is augmented by a social worker to assess family support and psychosocial needs), the home care team is well positioned to report to the oncology team regarding all eight “domains” of assessment criteria named by the ISGO.
Assessment criteria can be completed with home care insights
Because home care providers work in the home environment, they are able to observe and report on assessment criteria at a deeper level and serve as an extension of the oncology team into the patient’s life in their everyday environment.
To quote the Journal of Oncology Practice, “a full geriatric assessment should be performed in all patients with cancer age 70 years and older who are considered for any cancer treatment…The exact tools may differ as long as the geriatric assessment includes the [essential] domains.” Home care professionals can help to fill in the blanks.
For example, to describe the transition of a 58-year old, female leukemia patient from hospital to home, here is what a SeniorBridge Certified Nursing Assistant said:
Before we start home care for any cancer patient, there’s an assessment by the NCM (Nurse Care Manager), who exchanges information with the patient’s Oncology Nurse. We do a complete history, go through every record. Then we plan safety measures, food, hygiene, activity, and medications, always working within defined limits. Once the patient is home, I do daily reports and the NCM checks in every two weeks to monitor changes and get information. Plus there’s a monthly reassessment. That’s how we can be an extension of the eyes and ears of the oncology team and also the patient’s advocate.
The integrated care management model by SeniorBridge
Home care services vary widely in the services they provide.
SeniorBridge offers an integrated care management practice model that involves two components:
1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, nursing home admission, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.
NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.
For more information on cancer care at home, contact SeniorBridge.
Johns Hopkins Medicine
The International Society of Geriatric Oncology
NIH/Journal of Oncology Practice