Frailty Informed Treatment (FIT) pilot enhances support for older GI patients

The Southern Integrated Cancer Service (SMICS), has supported a 10-month pilot project at Monash Health aimed at improving outcomes for vulnerable older adults with newly diagnosed gastrointestinal (GI) cancer.

The Frailty Informed Treatment (FIT) project focused on enhancing care for patients aged 65 and older by identifying vulnerabilities early, tailoring treatment and supporting referrals to supportive and allied health services.

Dr Ranjana Srivastava, a medical oncologist at Monash Health, co-designed the FIT project with a team that included nurse practitioner, Vicki McLeod, SMICS Senior Project Manager Jodi Dumbrell, and received helpful input from several clinicians.

Dr. Srivastava specialises in geriatric oncology and is a staunch advocate for better doctor-patient communication to anchor patient-centred care. She is also an award-winning columnist for The Guardian newspaper where she writes on the intersection of humanity and medicine.

She explains the importance of the FIT initiative:

‘All cancer patients are vulnerable in their own way, but no patient is more vulnerable than an elderly cancer patient.

Elderly cancer patients are more likely to be frail and vulnerable from health conditions including cognitive impairment. They are at higher risk of falls, medication mix-ups, malnutrition and loneliness. To complicate matters, the elderly cancer patient is frequently caring for or being taken care of by another elderly person, so treating one patient necessitates thinking about the needs of two. 

For these reasons, these patients are deserving of meticulous care and concern – to defend against undertreatment, shield against overtreatment and take care of the whole person. When socioeconomic disadvantage is added to the mix, every problem becomes worse.’  Dr. Ranjana Srivastava, said.

The FIT project sought to improve outcomes for older patients through three key initiatives:

• Introduction of the American Society of Clinical Oncology (ASCO) Practical Geriatric Assessment (PGA) tool prior to starting treatment, enabling early identification of patient vulnerabilities.
• Establishing a Geriatric Oncology Multidisciplinary Meeting (MDM), where patients and their PGA results were reviewed to guide treatment recommendations.
• The project also funded a Geriatrician to provide expert assessment, follow-up, and care in the geriatric oncology clinic.

Together, these initiatives of the FIT pilot supported patient-centred care by aligning treatment with each individual’s needs.

SMICS Senior Project Manager Jodi Dumbrell, who co-designed the project, said, ‘the FIT pilot forms part of SMICS’ ongoing program of work supporting better outcomes for priority populations within our region. From planning to implementation and review, we were constantly asking ourselves how we could better support older patients within the constraints of the system we were operating in.’

She acknowledged the challenges faced during the pilot, particularly around staffing, governance, and clinician engagement.

‘Despite these challenges, the pilot returned positive results, especially in reducing hospital length of stay. This highlights the impact that providing tailored geriatric support to patients can have.’  

Results of the pilot showed that compared to patients receiving usual care, patients participating in the FIT pilot had improved outcomes, including:

• Higher completion rates of supportive care screening tools
• Increased referrals to allied health and support services
• Chemotoxicity risk screening completed for 95% of patients (vs. none in usual care)
• More frequent prescribing of chemotherapy at reduced initial doses
• Shorter hospital length of stay, likely due to enhanced support and tailored care.

The FIT Project shows the value of geriatric assessment in improving care coordination and outcomes for older GI cancer patients. SMICS is now undertaking work to explore opportunities to embed FIT into routine care for older cancer patients.

The findings of the FIT project will be presented in a poster at the Clinical Oncology Society of Australia (COSA) Congress next month.

You can read more about the FIT pilot here.