The Royal Marsden Diagnosis and treatment

Age concern: providing appropriate strategies

Cancer can strike at any age, and how patients react to treatment can be affected by what stage they are at in life. This is why The Royal Marsden is developing age-appropriate strategies for the best care.

Dr Ramanathan Kasivisvanathan and Dr Jamie McCanny

At The Royal Marsden, we treat the whole person and not just their disease. People are living for longer these days, and cancer can affect a person who is already weakened by age-related illness and infirmity.

On the other hand, a fit and otherwise healthy adult with family and work commitments can have their world turned upside down by a cancer diagnosis. They need a different approach, focusing on psychological and practical support for coping with this life-changing event.

Here, we highlight two new services that have been set up to provide age-appropriate support and care for our patients – before, during and after their cancer treatment.

Improving surgery outcomes for frail patients

As the population ages, the number of older adults with one or more chronic health problems, in addition to cancer, is increasing.

In response to more already frail patients requiring cancer surgery, The Royal Marsden, with support from members of the Patient and Carer Advisory Group, has developed a Surgical Frailty Transformation Programme.

The multidisciplinary service aims to identify and optimise patients with frailty as early as possible prior to major surgery.

Our team pre-emptively arranges helpful services, therapies and treatments to improve patients’ physical and mental health before, during and after surgery

Dr Jamie McCanny, Darzi Fellow for the Surgical Frailty Transformation Programme.

Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves, resulting in a disproportionate impact on physical and mental well-being.

“We now know that patients with frailty have poorer outcomes after major cancer surgery than their non-frail counterparts,” says Dr Ramanathan (Nathan) Kasivisvanathan, Consultant Anaesthetist and Clinical Lead Perioperative Assessment Services.

The pilot was launched in December 2016 in Chelsea for frail patients having intra-abdominal cancer surgery. The team aims to roll out the programme across the Trust by summer 2017.

Dr Jamie McCanny, Darzi Fellow for the programme, adds: “Our team pre-emptively arranges helpful services, therapies and treatments to improve patients’ physical and mental health before, during and after surgery.”

Supporting young adults with cancer

The Royal Marsden is planning to launch the UK’s first young adult (YA) programme to support cancer patients aged between 25 and 39. Professor Winette van der Graaf, Consultant Medical Oncologist, is leading the project after setting up a similar service in her native Netherlands.

“Care for young adults is different from that of children or older adults, as they have age-specific issues that need to be addressed,” says Professor van der Graaf, who also leads the Clinical and Translational Sarcoma Team at The Institute of Cancer Research.

“These patients are confronted with a life-threatening disease, and worry about careers, finances, partners, fertility and young children. They often feel lonely in their journey, as cancer is so uncommon at this age.”

Focus groups involving patients, nurses and consultants are being set up to help develop the service.

Dr Olga Husson, Research Fellow, says: “Organising contact with peers for these patients is an important part of the new YA programme. We’re also running a quality-of-life research project in order to get a better insight into the unmet needs of these young people.”