SMICS and Monash Health initiative supporting better care for vulnerable older adults with GI Cancer

FIT is an SMICS and Monash Health initiative supporting better care for older adults with Gastrointestinal (GI) Cancer

Older adults represent a significant proportion of cancer diagnoses in Australia, with 72% of new cases occurring in individuals aged 60 and over. This population often faces additional health challenges, increasing their vulnerability to treatment-related complications, hospitalisations, and diminished quality of life. In the SMICS region of South East Melbourne, there are notably higher rates of vulnerable older adults experiencing disability, social isolation, socioeconomic disadvantage, and reduced physical function. To address these challenges, SMICS, in partnership with Monash Health, established the Frailty Informed Treatment (FIT) Project.

FIT aimed at enhancing care for patients aged 65 and older with newly diagnosed GI cancers being considered for systemic therapy. The 10-month FIT quality improvement initiative was conducted at Monash Health’s Moorabbin Hospital and utilised the American Society of Clinical Oncology (ASCO) Practical Geriatric Assessment (PGA) tool to support early identification of patient vulnerabilities, inform treatment decisions, and support proactive care planning.

A key innovation of FIT was the establishment of a Geriatric Oncology Multidisciplinary Meeting (MDM), where patients and PGA results were reviewed to guide treatment recommendations. Additionally, the project funded a Geriatrician to provide expert assessment and care in the geriatric

oncology clinic. Compared to patients receiving usual care, FIT patients had significantly 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.

In addition, FIT demonstrated cost effectiveness through an MBS funding model and very positive patient and organisation outcomes. This has led to the appointment of two new roles to the geriatric oncology service at Monash Health- a Geriatrician and a Geriatric Clinical Nurse Consultant (CNC), ensuring optimal care provision continues to older persons with cancer.

The FIT pilot was co-designed by SMICS Senior Project Manager Jodi Dumbrell. For more information on the FIT Project, please contact SMICS@MonashHealth.org.