Geriatrician co-management for older patients having cancer surgery
When a geriatrician helps manage older patients around the time of a cancer operation, complications, delirium and hospital stays fall. This should be standard for anyone over 75 having major cancer surgery.
Perioperative geriatric co-management models (POSH at Duke, POPS in the UK) have shown reductions in complications, delirium, length of stay, and readmissions for older surgical patients. Cancer surgery in the over-75s is increasing and is where these gains are largest. Making co-management a standard component of surgical oncology pathways, with preoperative optimisation and postoperative geriatric review, is an organisational change with strong evidence.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
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