ideasIdea
A defined pathway for patients with both dementia and cancer
People with dementia who develop cancer are often either overtreated or written off, and decisions are made without them. A clear pathway for assessment, consent and treatment planning would improve both.
Dementia is common among older cancer patients and complicates diagnosis, capacity assessment, consent, adherence, and toxicity recognition. There is little guidance. A pathway combining cognitive screening at diagnosis, structured capacity assessment, involvement of carers and, where appropriate, advance care planning, simplified regimens, and supported adherence would reduce both undertreatment of those who could benefit and harmful treatment of those who cannot.
Hypothesis
Patients with dementia managed through a defined pathway will show higher rates of documented capacity assessment and goal-concordant treatment, and fewer emergency admissions during treatment.
Rationale
Comorbid dementia is a growing group with no evidence base; pathway approaches have improved care in hip fracture and delirium.
What would test it
Develop and pilot the pathway in five centres, measuring documentation of capacity and goals, treatment decisions, and admissions against historical controls.
Maturity
speculative
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
- 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.
- Patients lack understanding, navigation and agency · Most patients cannot understand their options, find trials, or push back, so decisions are made for them.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.