A new care paradigm in geriatric head and neck surgical oncology Journal Article

Authors: Shuman, A. G.; Korc-Grodzicki, B.; Shklar, V.; Palmer, F.; Shah, J. P.; Patel, S. G.
Article Title: A new care paradigm in geriatric head and neck surgical oncology
Abstract: Background and Objectives Perioperative management of elderly patients with head and neck cancer poses unique challenges. Our objective is to describe the implementation and feasibility of a novel intervention designed to improve perioperative care in geriatric head and neck surgery. Methods This pilot study was performed in a single-institution, NCI-designated comprehensive cancer center. All surgical patients with head and neck cancer over age 75 were offered perioperative consultation with fellowship-trained geriatricians focusing in geriatric oncology. Results Between 2010 and 2011, a total of 168 patients requiring head and neck surgery were seen by the geriatric service, of which 94% subsequently underwent surgery. Apart from preoperative medical optimization, geriatricians assisted in complex decision-making regarding the indications for cancer-directed therapy. Postoperatively, they assisted in preventing and treating delirium and poly-pharmacy, facilitating discharge planning, and initiating rehabilitation. Postoperatively, 87% were discharged home, and 13% required placement in skilled nursing facilities. At 24 months, overall survival was 80%. Patients, surgeons and geriatricians alike were enthusiastic about the initiative, which is expanding within the institution. Conclusion Geriatric perioperative support for elderly head and neck cancer patients is well-received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study. © 2013 Wiley Periodicals, Inc.
Keywords: cancer survival; controlled study; aged; aged, 80 and over; cancer surgery; major clinical study; overall survival; head and neck surgery; preoperative care; medical decision making; delirium; publication; cancer center; medical education; head and neck cancer; pilot study; head and neck neoplasms; pilot projects; surgeon; referral and consultation; consultation; hospital discharge; perioperative period; patient discharge; national health organization; geriatric care; nursing home; perioperative care; surgical patient; geriatric oncology; skilled nursing facilities
Journal Title: Journal of Surgical Oncology
Volume: 108
Issue: 3
ISSN: 0022-4790
Publisher: Wiley Blackwell  
Date Published: 2013-09-01
Start Page: 187
End Page: 191
Language: English
DOI: 10.1002/jso.23370
PROVIDER: scopus
PUBMED: 23813637
Notes: --- - "Export Date: 4 September 2013" - "CODEN: JSONA" - "Source: Scopus"
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MSK Authors
  1. Snehal G Patel
    291 Patel
  2. Jatin P Shah
    547 Shah
  3. Andrew Gregg Shuman
    23 Shuman
  4. Frank Palmer
    81 Palmer
  5. Victoria Shklar
    2 Shklar