Are Future Radiation Oncologists Equipped With the Knowledge to Manage Elderly Patients With Cancer?

PURPOSE: To assess radiation oncology (RO) trainee knowledge, attitudes, and clinical practice relating to geriatric oncology.

METHODS AND MATERIALS: A custom online survey was anonymously administered to RO trainees across Australia, New Zealand, and Singapore. The survey assessed 3 domains: (1) trainee demographics and prior training in geriatric medicine; (2) current clinical practice and attitudes regarding elderly cancer patients and radiation therapy; and (3) opinions regarding educational opportunities around geriatric oncology. The survey was developed and reviewed by radiation oncologists with expertise in education and training.

RESULTS: A total of 61 trainees (52%) responded to the survey. More than half had not undertaken a geriatric medicine term before RO speciality training. A total of 91.8% of respondents had not received teaching during RO training specifically regarding geriatric oncology. The use of geriatric assessment (GA) tools for determining suitability for radiation therapy was uncommon, with 80.3% of respondents rarely or never using them. More than two-thirds of respondents reported not seeking or rarely seeking multidisciplinary input from a geriatrician when assessing suitability for treatment. Trainees had low confidence levels in managing complex issues commonly observed in the elderly. Only 39.3% felt they had the confidence to manage these issues, with 31.2% not confident/not at all confident. Respondents reported functional status, assessment of comorbidity, physiologic age, and cognition as the major factors applied to treatment decisions. Input from a geriatrician was lowest ranked. Of factors influencing choice of dose/fractionation schedule, physiologic age ranked highest, whereas use of GA tool ranked the lowest. The majority of trainees (85.3%) agreed or strongly agreed they would benefit from more training around RO in elderly patients, and 65.6% felt the addition of learning objectives to RO curriculum around geriatric oncology would be valuable.

CONCLUSIONS: Radiation oncology trainees report inadequate training and experience in geriatric oncology and geriatric medicine. Radiation oncology trainees rarely use and poorly understand the rationale for GA tools and geriatrician input in clinical practice. Trainees strongly support improved education in geriatric oncology.