Senior adult oncology program at Moffitt Cancer Center- An innovative multidisciplinary care approach

Abstract

The Senior Adult Oncology Program at Moffitt is a pioneering Geriatric Oncology Care Model that focuses on a multi-disciplinary team approach to optimizing care of older adults. The team is comprised of dedicated medical oncologists, nurse practioners, medical assistants, nursing team, dietician, social work, and pharmacy who assess and treat the patient with a comprehensive approach, not only focusing on the cancer, but also addressing any physical, nutritional, and psychosocial issues that could impact their care.

Our approach starts with a nurse initiating a phone call to the patient within 72 hours of appointment scheduling. During this call, the SAOP3 Questionnaire is performed to identify any needs prior to the visit. If there is a negative screen, the patient proceeds with usual care and management with the oncologist. If there is a positive screen along a geriatric domain, this initiates further workup, and appointments are scheduled with the social work, dietician, and pharmacist for the day of the appointment. This allows patients to have a planned comprehensive evaluation on the day of the visit, without the burden of multiple followup appointments.

On the day of the visit, the medical assistant guides the patient to perform the Timed Up and Go test after completing the vitals, and the clinic nurse completes a mini-COG with the patient during the nursing evaluation. These evaluations are given to the oncologist prior to the oncologist’s visit with the patient. Once they have been completely evaluated, a treatment plan is made, taking into account all the other assessments that have been performed by the team. This plan is then discussed at a weekly tumor board, which is attended by all members of the program to get final input on the plan of care.

Throughout the patient’s care at Moffitt, the SAOP3, TUG, and mini-COG may be repeated at varying intervals, such as changes in treatment, after hospitalizations, or after falls. This is an ongoing area of research within our team to identify optimal time points for repetition of these assessments.