Geriatric Oncology Service For Senior Adults With Cancer
By Dr Donald Poon
Associate Consultant
Dept of Medical Oncology
National Cancer Centre Singapore

The need for specialised care of the elderly living with cancer is increasingly recognised globally. This interest in the relatively new field of subspecialty is fuelled by three factors. Firstly, an ageing population with increased cancer incidence imposes a greater disease burden. Secondly, the altered ability of drug handling in the elderly and combination of the interaction with increased comorbidities. Thirdly, a void in the clinical evidence for formulation of treatment guidelines.

In October 2006, a publication of the American Society of Clinical Oncology (ASCO) news forum placed geriatrics at the forefront of oncology. The National Cancer Centre Singapore (NCCS) has started a Geriatric Oncology service as part of its drive to provide comprehensive cancer care.

This service is aimed at incorporating comprehensive geriatric assessment tools to properly select elderly patients for treatment, prognostication, and tailored treatment. The tailored treatment is done by using state-of-the-art pharmacogenomic methods to minimise toxicities while optimising the effectiveness of therapy. A strong partnership with other specialists in the fields of clinical pharmacology, geriatrics medicine and palliative medicine is a key pillar of this new service.

A combined multidisciplinary inpatient round with the geriatricians has started successfully and active clinical research will allow the above ideals to be achieved. The NCCS was represented in last year’s International Society of Geriatric Oncology 6th Annual Meeting.

Dr Donald Poon¹ and Dr Joanne Ngeow presented NCCS’ work – an analysis of the impact of age, performance status, and comorbidity on clinical outcomes in treatment of elderly patients with non-small cell lung carcinoma. This analysis was completed in an NCCS trial SQLU01 of which Dr Leong Swan Swan was the Principal Investigator. Further research will be done in NCCS to refine treatment algorithms with pharmacogenomics profiling.

The outpatient geriatric oncology service was launched in March this year and an active international collaboration in clinical research has blossomed between the two centers. More clinical research projects are to be in the pipeline.


¹ Dr Donald Poon recently completed a HMDP stint in H. Lee Moffitt Cancer Centre in Tampa, Florida, where the world’s first geriatric oncology programme has been operating for the last 10 years. Dr Poon is also the President of the newly formed Society of Geriatric Oncology (Singapore).