Are future Radiation Oncologists equipped with the knowledge to manage elderly patients with cancer?

Publication date: Available online 9 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lucinda Morris, Niluja Thiruthaneeswaran, Margot Lehman, Gina Hasselburg, Sandra Turner
PurposeTo assess radiation oncology (RO) trainee knowledge, attitudes and clinical practice relating to geriatric oncologyMethods and materialsA custom online survey was anonymously administered on RO trainees across Australia, New Zealand and Singapore. The survey assessed three domains:1. Trainee demographics and prior training in geriatric medicine2. Current clinical practice and attitudes regarding elderly cancer patients and radiation therapy3. Opinions regarding educational opportunities around geriatric oncologyThe survey was developed and reviewed by radiation oncologists with expertise in education and training.ResultsA total of 61 (52%) trainees responded to the survey. Over half had not undertaken a geriatric medicine term prior to RO speciality training. 91.8% of respondents had not received teaching during RO training specifically regarding geriatric oncology.The use of geriatric assessment (GA) tools for determining suitability for radiation therapy was uncommon, with 80.3% of respondents rarely or never using them. Over two thirds of respondents reported not seeking or rarely seeking multidisciplinary input from a geriatrician when assessing suitability for treatment.Trainees had low confidence levels in managing complex issues commonly observed in the elderly. Only 39.3% felt they had the confidence to manage these issues with 31.2% not confident/not at all confident.Respondents reported functional status, assessment of co-morbidity, physiological age and cognition as the major factors applied to treatment decisions. Input from a geriatrician was lowest ranked. Of factors influencing choice of dose/fractionation schedule, physiological age ranked highest, whilst use of GA tool ranked the lowest.The majority of trainees (85.3%) agreed or strongly agreed they would benefit from more training around RO in elderly patients. 65.6% felt the addition of learning objectives to RO curriculum around geriatric oncology would be valuable.ConclusionsRO trainees report inadequate training and experience in geriatric oncology and geriatric medicine. RO trainees rarely use and poorly understand the rationale for GA tools and geriatrician input in clinical practice. Trainees strongly support improved education in geriatric oncology.

Teaser

The education of future radiation oncologists in geriatric oncology is fundamental to ensuring the complex needs of elderly cancer patients are met. This study assesses radiation oncology (RO) trainee knowledge, attitudes and clinical practice in geriatric oncology via a national survey. We conclude that RO trainees receive little education around geriatric oncology, rarely apply appropriate geriatric assessment tools or multidisciplinary input into clinical practice and would benefit from receiving improved training around RO in elderly patients.


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