One-stop service transforms care for older cancer patients living with frailty
A new service at St Bartholomew's Hospital is improving care for older cancer patients living with frailty by bringing specialists together in a single clinic.
The Older Adult Cancer Service (OACS) supports patients whose frailty can make cancer treatment more challenging, increasing the risk of side effects, falls, hospital admissions and loss of independence.
Rather than attending multiple appointments, patients receive a comprehensive assessment during one extended visit, meeting specialists including a geriatrician, nurse specialist, physiotherapist, occupational therapist, speech and language therapist, dietitian and pharmacist. This helps identify needs that may otherwise be missed and enables earlier access to support.
The multidisciplinary team carries out a detailed "whole-person" assessment, considering mobility, nutrition, medications, independence and wellbeing alongside cancer care.
The aim is to identify problems early, help patients tolerate treatment and ensure they are fully involved in decisions about their care.
Demand for services like this is growing. More than two-thirds of cancer diagnoses are in people aged 60 and over, while increasing numbers of older adults are living with frailty and other complex health conditions.
Patients and carers helped design the service through a patient and public involvement and engagement group. Feedback has been overwhelmingly positive, with many patients praising the personalised approach and opportunity to discuss concerns beyond their cancer treatment.
Trevor Inglis, 75, from Woodford, east London, who was referred to the clinic as part of his prostate cancer care, described it as a "Rolls-Royce service".
He said: "They assess you from head to toe, including your physical health and your mental wellbeing. I had a few worries, but the team really put my mind at ease. The physiotherapy has been brilliant and is helping to keep me as mobile as possible. I'd recommend the service to anyone."
The service is also helping to share expertise across the NHS. Since launching, the team has delivered teaching sessions to around 150 healthcare professionals and welcomed clinicians from other organisations to observe the clinic.
Working with the Specialised Clinical Frailty Network, the team has benefited from quality improvement support and had two abstracts accepted for presentation at the International Society of Geriatric Oncology conference in November.
The two-year pilot is funded in part by Barts Charity. The team is evaluating its impact on patient experience, treatment completion, side effects and emergency admissions, while working with oncology centres across the UK and Barts Health's Academic Centre for Healthy Ageing to share learning.
Dr Kirsty Balachandran, consultant medical oncologist and OACS service lead (pictured), said: "This service gives us the time and expertise to look at the bigger picture, helping patients stay as well and as independent as possible throughout their treatment. We're already seeing the difference that more coordinated support can make."
Barts Charity chief executive Fiona Miller Smith said: "We're proud to support the Older Adult Cancer Service as part of our wider commitment to improving health for older people across east London."
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