In this episode of The Oncology Republic Podcast we dig into the finer points of using comprehensive geriatric assessment in the management of older people with cancer. 

Dr Paul Viray, a Melbourne-based consultant geriatrician and medical oncology registrar, feels there are misconceptions about what a comprehensive geriatric assessment is. He describes it more of a specific approach to medicine, rather than a specific tool or set of forms.  

“The comprehensive geriatric assessment is the method of holistically going through all aspects of an older person’s life and finding out how to optimize each of those things, [such as] continence and cognition, how many medications they're taking, what their mobility is like, their falls risk, their nutritional status.” 

Dr Michal Krasovitsky, a medical oncologist at the Kinghorn Cancer Center at St Vincent's Hospital in Darlinghurst, has worked closely with colleagues at the Cancer Institute NSW to make it easier for clinicians to access evidence-based screening tools that can be used in geriatric screening. He is pleasantly surprised by the results of their efforts. 

“Registrars who I've been working with have all used the tool, and a number of my [other] colleagues have also used the tool. And even more impressively, in my mind, the non-medical oncology people I work with, including surgeons and radiation oncologists have also used the tool… and then using that as an opportunity for us to brainstorm what we’re going to do with that information [has been] extremely powerful.” 

Dr Viray has been developing his own approach to comprehensive geriatric assessment, which he hopes will break down some of the barriers between different specialties. 

“There’s this siloing of specialties, so geriatricians do this, cardiologists do that. Oncologists do this, radiation oncologists do that. If we work together, I think that would take away some of the angst oncologists [have], and [to build] another workforce to help our oncologists.” 

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This episode of The Oncology Republic Podcast explores how the field of geriatric oncology has grown in Australia, and some of the challenges it faces. 

Dr Paul Viray, a consultant geriatrician and medical oncology registrar who works across several sites in Victoria, says the geriatric oncology community in Australia has grown because of increased awareness about managing older patients in a more holistic fashion. 

“If you spend a bit more time in the holistic care of the older adult, it’s so rewarding. And I think a lot of people want to do that more and more.” 

Dr Michael Krasovitsky, chair of the Geriatric Oncology Multidisciplinary Service at St Vincent's Hospital in Darlinghurst, feels our nation’s “abysmal” funding model for geriatric oncology means we become reliant on having an engaged and inclusive community.  

“Navigating the funding arrangements are extremely difficult, and ultimately to the detriment of patients. You need to come up with some sort of fake model of care that works in your specific hospital situation, which requires local champions often begging administrators to provide funding. 

“We now have our geriatric oncology emerging experts and researchers group, [which is] a really sizeable group of people who are engaged in researching and collaborating with overseas clinicians. That’s been really invaluable.” 

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As a health professional she also had the benefit of health literacy and a personal assertiveness that may have well also helped her be at her daughter’s 10th birthday. 

“There were lots of ‘sliding door’ moments.  If I hadn't asked a certain question or pushed for a different answer or gotten a second or third opinion, then the outcome would be very different,” she says. 

The epicentre of Ms Delaney’s survival is genetic testing. She says it’s critical because it opens the doorway to emerging new treatments, personalized medicine and clinical trials. 

“These are critical for all cancer patients, but especially for rare cancer patients whose treatment options may be limited,” Ms Delaney said 

Ms Delaney was diagnosed with stage 4 clear cell ovarian cancer nearly seven years ago. She is enthusiastic about PROSPECT a new cancer treatment pathway that provides genomic testing to Australians with rare or incurable cancers, and then provides access to any clinical trials and off-label therapies that might make a difference. 

PROSPECT cancer screening program is a clever collaboration between University of New South Wales, NSW government and a whole range of players in the Australian medical research sector.  

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Professor David Thomas leads Omico, the not-for-profit which runs PROSPECT’s cancer screening program. He is optimistic about PROSPECT bringing a bit more equity to cancer treatment for those with rare cancers who often miss out on trials or are and also for remote patients. 

“Regional and rural Australia is very important to us and we're specifically trying to promote the program and work with our clinical colleagues in regional cancer centers.  

“That specifically applies also to Aboriginal and Torres Strait Islander cancer patients. Rural and regional patients, as well as Indigenous cancer patients, have demonstrably worse outcomes. We don't want them to be left behind,” he says. 

For the 150 people diagnosed each day with a rare cancer, it’s a new pathway that can make the difference and not just in the future. Professor Thomas says the program is not a philanthropic exercise with no connection with patient interests. 

“The pace of research progress is so great that it's now creating options for patients in real time rather than for some future benefit.  

“I would encourage us to think about research as just another part of the way of our armamentarium when we try to treat diseases like cancer,” he says. 

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However, for many doctors, this end-of-life option is surrounded with complexity and conundrums. 

In a two-part series Oncology Republic podcast explores the legislation, support network and personal experience of doctors engaged in Voluntary Assisted Dying (VAD). 

This episode we speak with Casey Haining, research fellow in the Australian Centre for Health Law Research, at Queensland University of Technology. She shares the recent changes in legislation.  

Ms Haining says that a “particularly prominent legal concern” for many doctors is breaching the Commonwealth Criminal Code by talking about voluntary assisted dying through a carriage service. 

“Because of this Commonwealth law there is a bit of hesitation around talking or conducting aspects of the voluntary dying process via telehealth. It is a grey area in terms of the interpretation and different states have interpreted it quite differently,” she says. 

Ms Haining encourages doctors to access the Centre for Health Law Research website  that provides jurisdiction specific information and provides an overview on other aspects of end-of-life law. 

MBS also needs to adapt to the new legislation, Ms Haining said. MBS currently only provides patient rebates for consultations for VAD eligibility. There is no rebate for the actual administration. 

“VAD is not a quick process and it takes a lot of time for practitioners. Because this is going to be a lawful choice across juridictions the MBS needs to ensure that people who are dedicating themselves and electing to provide this lawful service are compensated adequately,” she said. 

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