A 12-month implementation geriatric oncology program: from pilot to new model of care in a rural cancer service

Abstract

Background: Approximately 30% of Australians live more than 160 km from metropolitan centres, limiting access to specialist care and advanced treatments. Western District Health Service (WDHS), serving a rural population with a high proportion of elderly cancer patients, previously provided standard cancer care. However, older patients are more vulnerable to treatment-related toxicity, hospitalisation, and mortality. To address this, WDHS piloted a new approach over 12 months, which yielded positive outcomes. Methods: The pilot integrated the Practical Geriatric Assessment (PGA) and a Geriatric Oncology Multidisciplinary Meeting (MDM). Patients aged 70 and over were selected by the local oncologist for a nurse-led PGA. A Melbourne-based geriatric oncologist joined the fortnightly MDM via Telehealth. The local team included a dietitian, physiotherapist, occupational therapist, psychologist, complex care nurse, and palliative care nurse. Team members also led education sessions on geriatric oncology topics. The MDM issued formal care recommendations and tracked referrals. Feedback from patients and staff was collected to assess the model. Impact on Practice: 1. PGAs are now standard for patients aged 70+, with opt-out available. Assessments are triaged and discussed at the supportive care meeting to improve referral pathways. 2. The NCCN Distress Thermometer is used during initial assessments to identify patient and carer stressors. 3. Cases are reviewed fortnightly in MDMs with input from both metropolitan and local clinicians and allied health staff. 4. A dedicated oncology nurse now coordinates the program, ensuring evidence-based care and follow-up. 5. The model promotes holistic, patient-centred care aligned with best practice. Discussion: The successful integration of PGA and geriatric oncology MDM into WDHS services has enhanced multidisciplinary decision-making and improved patient support. Patients report feeling more supported throughout their cancer care journey.