60% of cancer occurs in people over age 65. By 2030, 20% of the U.S population will be 65 years or older. This population is under represented in oncology clinical trials and there is limited knowledge on how they respond to and cope with oncology treatment. We have a responsibility to identify and manage the distinct biopsychosocial needs of older adults.

Social Work Leadership and Distress Screening Develop a Geriatric Oncology Psychosocial Program Daisy Rivera, LCSW, Arti Hurria, MD,

Peggy Burhenn, CNS, Matt Loscalzo, LCSW, amd Nellie Garcia, LCSW, MSG

BACKGROUND

PURPOSE

METHODS

BARRIERS

1. The purpose of this project is to create a model of geriatric care using a geriatric assessment to guide interventions.

2. Include complementary and alternative medicine (CAM) interventions as treatment options .

3. Expand professional education about geriatric care.

• A geriatric social work position was created to enhance focus . • A multidisciplinary team consisting of a geriatric oncologist, social worker, and nurse practice leader was formed in June, 2014. •A qualitative 12 month study of listserv postings of social work oncology network was conducted which identified that social workers are at the forefront of distress screening. • A validated geriatric assessment was initiated in a medical oncology clinic beginning in November, 2014. • Additional team members added in February, 2015, including SupportScreen staff and a statistician to assist with integrating the geriatric assessment into clinic .

• 25 minutes for patient to complete self reported geriatric

assessment. • Clinician time needed to review results of geriatric assessment prior to visit. • Interdisciplinary referral coordination and follow up . • Need a support staff position to facilitate workflow.

FUTURE DIRECTIONS

• Expand the availability of CAM interventions. • Our aim is to standardize implementation of the self- administered geriatric assessment in all oncology clinics for patients 72 and older. • Spanish version of the geriatric assessment has been validated and is pending roll out to the clinic setting. Our hope is translate and validate this assessment in Chinese as well. • Utilize computerized technology to promote geriatric education.

OUTCOMES

• A social worker in the clinic allows for timely practical referrals, quality of life, and goals of care discussions to occur in real time. • Creating a standard workflow for a geriatric assessment in the clinical setting. • 40 geriatric assessments have been conducted. • Reiki therapy is being offered to patients who do not respond to traditional interventions. • This project uncovered an educational need on delirium ; therefore an educational seminar to Social Work Division and Rehabilitation Team focused on delirium was provided.

TARGET AREAS GOALS

Geriatric Assessment

1. A clinical process in a geriatric oncology clinic including a geriatric assessment on patients 72 and older.

2. Expanding to other clinics as standard of care.

Complementary and Alternative Treatment

1. Develop criteria and referral process for older adults with cancer.

2. Establish community partnerships and collaboration with CAM providers.

3. Provide education to patients and staff on CAM benefits in geriatric population.

Patient and Caregiver Education 1. Develop orientation class to educate on

resources and services which are specific to older adults with cancer.

Institutional Awareness of Geriatric Oncology Needs

1. Identify learning needs of staff related to the care of older adults with cancer.

2. Provide training to staff.

CHRONOLOGICAL AGE ≠ FUNCTIONAL AGE

REFERENCES

COMPONENTS OF A GERIATRIC PSYCHOSOCIAL PROGRAM GERIATRIC ASSESSMENT TOOL

1. Hurria, A., Togawa, K., Mohile, S. G., Owusu, C., Klepin, H.D., Gross, C.P., Lichtman, S.M., Gajra, A., Bhatia, S., Katheria, V., Klapper, S., Hansen, K., Ramani, R., Lachs, M., Wong, F.L., & Tew, W.P. (2011). Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol, 29(25), 3457-3465.

2. Loscalzo, M., Clark, K., Dillehunt, J., Rinehart, R., Stowbridge, R., & Smith, D. (2010). SupportScreen: A model for improving patient outcomes. JNCCN Journal of the National Comprehensive Cancer Network, 8(4), 496-504.

3. Fleisher, K.A., Mackenzie, E.R., Frankel, E.S., Seluzicki, C., Casarett, D., & Mao, J.J. (2014). Integrative reiki for cancer patients: A program evaluation. Integrative Cancer Therapy, 13(1), 62-67.

For more information, please contact Daisy Rivera, LCSW at drivera@coh.org