ideasIdea
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.
Hypothesis
Co-management will reduce postoperative complications and delirium by at least 25% and length of stay by two days in patients over 75 having major cancer surgery.
Rationale
The evidence base is consistent across settings; the barrier is geriatrician availability and funding, both of which can be addressed by shared roles and payment.
What would test it
A stepped-wedge implementation across ten surgical oncology units with complications, delirium, length of stay, readmission, and functional recovery as endpoints.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
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.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.