A tool to streamline hospital outpatient clinics for geriatric oncology patients has been developed by a clinical pharmacist and clinical nurse specialist at the Royal Marsden NHS Foundation Trust.
The eArly identifiCation advanCed gEriatric aSsesSment (ACCESS) tool facilitates integrated care by remotely assessing medications, nutrition, social support, mood, and functional status, enhancing clinical efficiency and patient outcomes.
It is used by the Trust’s Senior Adult Oncology Programme, which supported the tool’s development and provides multidisciplinary geriatric assessment and interventions for patients aged 70 years and older undergoing systematic anticancer therapy. It is the first multidisciplinary team of its kind embedded in a specialist cancer centre in the UK.
Complex needs of older adults with cancer
Comprehensive geriatric assessment is crucial for addressing the complex healthcare needs of older adults, including those with cancer. Such assessments significantly improve tolerability of both localised and systemic anticancer therapies. International guidelines strongly advocate incorporating geriatric assessments into routine oncology care, which drove the creation of the ACCESS tool.
Core components of the tool include medication review, patient counselling, deprescribing and comorbidity management, closely aligned with the Royal Pharmaceutical Society’s Advanced Pharmacy Framework.
Improving efficiency and patient confidence
Implementation of ACCESS occurred from January to December 2022, beginning with screening of geriatric patients. These patients then underwent detailed remote consultations, via telephone or video, conducted by a specialist pharmacist and nurse, with follow up and support where necessary from the medical oncologist lead, allied health professionals and administrative staff.
During implementation, retrospective audits demonstrated existing deficiencies in medication management. Of the 103 patients assessed, 34% had medication adherence issues, notably involving proton pump inhibitors (40.8%), antidiabetic medications (27.2%), statins (27.2%) and antihypertensives (14.6%).
A targeted review of 22 breast cancer patients showed high rates of inappropriate medication (72.7%), adherence difficulties (81.8%) and anticancer therapy interactions (50%).
Throught the use of ACCESS, this led to pharmacist-driven interventions such as medication adjustments (90.1%), adherence counselling (40.9%) and deprescribing (31.8%).
Clinician and patient feedback indicated improved clinic efficiency, enhanced care coordination, and greater patient confidence.
Geriatric oncology tool rollout
While acknowledging initial challenges in implementing ACCESS as a new intervention to a well-established service, the team said: ‘The success of the ACCESS tool is a testament to the power of multidisciplinary collaboration. The engagement of a diverse team of healthcare professionals ensured a holistic approach to patient care and facilitated the successful implementation of the tool.’
Future plans for this work include regularly updating the ACCESS tool using continuous feedback and new evidence, alongside staff training.
The SAOP team aims to expand ACCESS to other oncology outpatient settings with geriatric patients through pilot studies and phased rollouts. Further dissemination plans via publications, conferences, workshops, electronic health record integration and ongoing impact evaluations will maximise the tool’s benefits, they said.
Reference
Slavova-Boneva, V., Barrell, A. & Battisti, N.M.L. Clinical Pharmacist and Clinical Nurse Specialist led medicine optimisation and medication adherence via eArly identifiCation advanCed gEriatric aSsesSment (ACCESS) tool in Senior Adult Oncology Programme (SAOP). Int J Clin Pharm (2025).
