National Survey Reveals Need for Geriatric Training in the Fellowship Setting

August 24, 2017

A new, national study finds there is a critical need to better integrate geriatric education into oncology fellowship training. The study, sponsored by the American Society of Clinical Oncology, and published in Journal of Oncology Practice (JOP), evaluated hematology/oncology fellows’ education, clinical experiences, and perceived proficiency in geriatric oncology.

Previous research has indicated that knowledge and skills in geriatric medicine are important to fold into the training of cancer physicians. More than half of patients diagnosed with cancer are over the age of 65, and by 2030, this number is expected to grow to two-thirds of all cancer patients. While the majority of cancer patients in this country are older Americans, how best to address the unique health issues of this aging population is not always routinely or consistently discussed in general oncology clinics.

The ASCO survey not only supports previous findings on geriatric oncology training, but also fills a key knowledge gap—this is the first national survey of United States based hematology/oncology fellows that specifically assesses their perspectives on geriatric training.

The study included the results of 138 respondents attending the 2013 American Society of Clinical Oncology Annual Meeting who visited the meeting’s trainee and junior faculty lounge.

The survey was divided into sections that measured:

  • Quantity and Quality of Education in Geriatric Oncology
  • Knowledge in Geriatric Oncology
  • Clinical Performance and Confidence in Geriatric Oncology

While most fellows rated geriatric oncology as “important” or “very important,” gaps were found in their fellowship training:

  • Only 25% reported having access to a geriatric oncology clinic
  • Only 19% were receiving or had received specific geriatric training during their fellowship
  • 53% reported having no lecture on geriatric oncology

Though the study’s sample size is relatively small, it highlights several generalizable areas for improvement and better integration of geriatric training in clinic. Additionally, the high value the survey respondents placed on geriatric oncology suggests that most fellows would be receptive to training in this specific area. The authors also make recommendations to improve geriatric oncology among hematology/oncology fellows:

  1. Develop and disseminate a minimum set of core competencies aligned with the fellowship general and curricular milestones.
  2. Encourage and expand use of existing educational materials such as the ASCO University® modules and tailor fellowship program requirements, didactics, or competencies around their incorporation.
  3. Develop educational materials in geriatric oncology that are more widely accessible across institutions, including but not limited to ASCO’s geriatric oncology resources.
  4. Find ways to consolidate formal geriatric oncology clinical experiences within currently existing rotations (e.g., palliative medicine, continuity clinics elective/selective blocks).
  5. Routinely incorporate geriatric oncology issues when discussing cases during fellows’ case report conferences, tumor boards, and related didactics wherever possible and invite geriatricians and palliative medicine care providers to such discussions to offer their insights.
  6. Continue supporting ongoing efforts within ASCO’s in-service exams, annual meeting planning, educational sessions, and related publications that promote awareness of geriatric oncology issues.
  7. Identify geriatrics/geriatric oncology champions at local institutions to help fill these knowledge gaps within the training program and foster collaboration.

Read the full article in JOP.