In the next 10-30 years, geriatric oncology will face a threefold challenge:
1. By 2050 Americans age 65+ will represent about 20% of the total population
2. Cancer will continue to impact older people more than other population segments, and
3. Geriatric oncology may not be adequately staffed to meet the coming need.
Home care providers with experience in caring for geriatric cancer patients will be positioned to support care and help mange patient volume.
This article examines ways in which home care services can fill those gaps.
“The silver oncologic tsunami”
In a 2019 Cancer Treatment Centers of America (CTCA) article, the CTCA warns of the “silver oncologic tsunami.” The incidence of prostate cancer, for example, is expected to be 2.5 times higher in 2030 than in 2017.
New models for delivering care are under development. For example, Hospital at Home (HaH) models are yielding evidence of reduced hospitalizations and infection rates. But HaH care models are still unevolved in the United States and haven’t achieved significant market penetration.
[There are many reasons for this. Inpatient and outpatient cancer treatment are still the traditionally accepted models of care delivery. Providers and patients often have a historical bias for clinical care. Plus, payer policies regarding reimbursement tend to preserve the status quo.]
However, home care services – designed specifically for cancer patients and their family caregivers – may be able to fill a critical gap now and in the decades ahead.
of all cancer patients receive treatment at home
New England Journal of Medicine 2020
There is significant room for growth in home cancer care in the next 5-10 years if oncology treatment plans are augmented by home care services. Home-based care has been shown to improve patient satisfaction and health as well as lower costs (compared to inpatient care).
Before treatment: Collaboratively examine pre-existing conditions
The CTCA article cites knowledge of pre-existing conditions as central to effective care. “The biggest problem we face in treating our geriatric cancer patients is their co-morbidities, or additional conditions that occur alongside cancer and its side effects," said Dr. Larry Ladi, MD, FCCP.
Among the comorbidities identified were COPD, cardiovascular disease, and renal and liver failure as well as conditions common to the elderly such as frailty, risk of falls, cognitive decline, and incontinence.
Home care, whether it is already present to support the patient and caregiver or activated with a cancer diagnosis, may be of value to the oncology team because of the day-in, day-out awareness of the patient’s pre-existing and evolving physical and emotional conditions.
Following treatment: Support patient and caregiver reactions
Home care professionals can support oncology teams by monitoring patient reactions to treatment.
• Understand pain tolerance. Home care providers can offer information and insight to how a patient copes with pain and discomfort. Some patients refuse to complain. Others are very vocal. Many are averse to the use of narcotics. Because of their deep knowledge of the individual, home care providers can help interpret patient pain thresholds accurately.
• Reduce caregiver stress. Family caregivers’ emotional and physical stress is often compromised during and after treatment. The exact extent to which their ability to provide care is compromised can be better understood by a home care provider who is in the environment and able to provide counsel, information, and relief.
• Improve patient’s quality of life. Because home care providers often have a strong baseline understanding of the patient’s lifestyle and life spirit, they can add insight to the impact of treatment on the patient’s physical state and emotional outlook. In-home caregivers can also reduce isolation, facilitate travel, and add special experiences to the life of the patient.
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
NCCN Practice Guidelines in Oncology
American Society of Clinical Oncology